Treatment-induced Menopause:
Facing the Issues

What is the menopause?
▼ Combination drugs: increased toxicity to The menopause is a natural hormonal process,during which tie the woman’s oestrogen levels ▼ Age: increased risk of ovaries failing over the gradually fall, and there is an increase in follicle age of 35. Younger women are also at risk, stimulating and lutenising hormone. As a result, the woman’s periods become irregular, and ▼ Fertility status/previous treatments: in general eventually stop altogether. She may experience physical and psychological changes and there is years experience premature ovarian failure a risk of osteoporosis and heart disease (see Table The average age for the menopause is 50 years, and a woman is described as post-menopausal ovarian function before cancer treatment.
when her period has not returned for one year.
Some treatments for gynaecological cancer maylead to premature ovarian failure, and induce ▼ Both ovaries removed (bilateral
oophorectomy): sudden onset of menopausal
symptoms can occur post-operatively.
One ovary removed or simple hysterectomy:
Even when one ovary remains, there may be The impact of various chemotherapeutic agents an advance onset of the menopause, but does ▼ Type of drug used: some drugs are known to ▼ Oophoroplexy (moving the ovaries): Surgical
transposition may alter the blood supply to ▼ Dose: high dose increases risk of ovarian used in the treatment of ovarian cancer.
Short term/immediate symptoms
Intermediate symptoms
Long term risks
Drugs with severe
Drugs with moderate
Drugs with less effect
Drugs with unknown
effects on ovaries
effects on ovaries
on ovaries
effects on ovaries
Research on thesenewer drugs is limited.
They are thought tohave a moderate effecton ovarian function,but there remains adegree of uncertaintyfor the women ▼ Pelvic radiotherapy: Ovaries are markedly
susceptible to radiation effects. But this is natural benefits of oestrogen, she may wish to give particular consideration to how she canmanage the change. There are many choices, a) Radiation dosage: 2-3 fractions can results and this article will focus on life style in premature infertility and 10-13 fractions management and non-hormonal management of can induce an early onset menopause.
Symptoms may not always occurimmediately, more commonly occur within a What can the woman do to help
b) Women’s age: Radiation tolerance of the ovaries is reduced over age 35 years, but all symptoms, severity and duration will vary, and women undergoing pelvic radiotherapy are at chooses to try. Some of the choices are based on What is a treatment induced
other women’s experiences of what they found premature menopause?
useful, and anecdotal evidence rather thanproven research trials.
This differs from a natural menopause, as there isa sudden rather than gradual change in hormone Hot flushes
levels as a direct side effect of cancer treatment.
How quickly this will occur can vary from report, affecting four out of five women. They woman to women, and also depends on the type can occur at any age if oestrogen levels are of treatment. For example, surgically removing reduced, and vary in severity and duration.
the ovaries will have an immediate effect, butchemotherapy and radiotherapy can take several ▼ Keep a diary of your hot flushes: you may see hot flushes at a particular time of day or in a particular situation. You may be able to avoid onset of symptoms, her period stops, and does not return within a year. At a time when a situations if you feel they exacerbate the challenge relating to a cancer diagnosis, the ▼ Choose your clothes carefully: wear natural treatment and its side effects, the overall impact fabrics next to your skin rather than synthetic.
of the menopause may be exacerbated. The fact Cotton night clothes and bed linen may be more comfortable, particularly if you suffer flushes, however, research has not proved them more easily during a hot flush.
▼ Find ways to cool down quickly: keep a reported benefits from this vitamin during the bottle of iced water near you, use a spray such as “evian spray mist”, and carry a small research has not proved its suggested benefits showers, and keepthe room well ventilated, in reducing hot flushes. It is important that particularly at night if prone to night sweats.
▼ Cut down on smoking (and if possible stop vitamin B6, and it should only be taken in completely): it is reported that the first puff of each cigarette can trigger hot flushes.
packet). Side effects have been reported withhigh dose vitamin B6.
▼ Take regular exercise: it improves your circulation, and may help manage or reduce Clonidence (Dixarit): this form of medication the intensity and frequency of hot flushes as may reduce the severity and frequency of hot the body adapts to coping with extremes of flushes. Like all drugs, it may cause side- effects: dry mouth, dizziness and nausea havebeen reported. Clonidine is being used less ▼ Limit foods and drinks which trigger your hot flushes: this is individual to each woman. If you note that certain foods and drinks trigger hot flushes and night sweats, try to reduce them in your diet. These may include spicy Progesterone: this form of medication may be prescribed to reduce or relieve hot flushes.
chocolate, alcohol, tea, coffee and soft drinks Side effects may include abdominal bloating, containing caffeine. Limiting hot drinks late breast tenderness, increased appetite and at night may help to reduce night sweats.
These affect the blood vessels, and may make usually only prescribed short-term if being used to treat hot flushes and it may not suitevery woman.
▼ Relaxation techniques: any exercises which help you unwind and reduce stress may help Vaginal dryness
▼ Water based lubricants are recommended listening to relaxing music or tapes may be (available to buy over the counter), Replens ▼ Complementary therapies: therapies that may Astraglide (available by mail order).
promote a feeling of well being during the Osteoporosis
menopause, and may help you cope with thehot flushes are: aromatherapy, homeopathy, The National Osteoporosis Society recommends the following daily allowances of calcium: acupuncture and yoga. It is essential that you Menopausal woman without HRT – 1500 mg consult a qualified therapist specialising in the field, and also liaise with the doctortreating your cancer.
The body absorbs calcium from food better thanfrom calcium supplements.
▼ Taking gammalinolenic gcid (GLA): this is found in evening primrose oil and efemast, Bisphosphonates
containing various amounts of GLA (which is elendronate, are currently licensed for the thought to be the active ingredient). Always follow the instructions regarding daily dose osteoporosis. Controlled clinical trials show they on the label, or check with your doctor or may offer long-term prevention of bone loss in nurse. Many women have reported that theyhave found these oils useful in reducing hot those who suffer from osteoporosis, by trying to Useful addresses
prevent the natural turnover of bone.
The Amarant Trust
However, they are poorly absorbed and must not medication or calcium supplement. Some womenmay find them difficult or inconvenient to take.
Reported side-effects include nausea, abdominal The National Osteoporosis Society
Etidronate (Didronel)
May be prescribed by a doctor, and is taken on a 90 day cycle. 400 mg etidronate disodium dailyfor 14 days, followed by 500 mg calcium supplement for the next 76 days. The cycle is The Women’s Nutritional Advisory Service
repeated and continued for a recommended three years. It is taken with water or fruit juice, on anempty stomach two hours before food.
Alendronate (fosamax)
It is stronger than etidronate, and also needs to be
Suggested reading
The Natural Menopause
continuous basis. It needs to be taken with a full Dr Mirian Stoppard. Dorling Kindersley. Cost glass of water 30 minutes before breakfast, and you need to remain upright for 30 minutes aftertaking each dose. Research has shown an Is HRT Right for You?
increase in average bone mineral density with its Dr Anne MacGregor. Sheldon Press. Cost £9.99 Understanding the Menopause
Raloxifene (selective oestrogen receptor
Understanding HRT and the Menopause
These are widely known as “SERMS”, and are the Dr Robert CD Wilson, Which? Consumer Guide.
latest non-hormonal treatment to prevent bone loss. Early research indicates that raloxifene mayprotect against cardiovascular disease and Healthy Eating – A Guide for Cancer Patients
osteoporosis, with no known risk of causing Hochland Communications Ltd, 0161 929 0190 cancer of the womb or breast. Raloxifene (one ofthe first “SERMS”) is now licensed for the Overcoming Eating Difficulties
prevention of osteoporosis in the UK. However, Hochland Communciations Ltd, 0161 929 0190 all the present SERMS can cause hot flushes and The Menopause, HRT and You
sweats and there is no evidence that they willalleviate the other physical or psychological symptoms that women may experience due to apremature menopause.

Source: http://www.gdq53.dial.pipex.com/Factsheet26.pdf

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