Managing your Symptoms of Menopause after Cancer Treatment

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1 Managing your Symptoms of Menopause after Cancer Treatment Information for women who have finished treatment UHN Read this handout to learn about: What are the symptoms of menopause? Will my periods come back? What helps to manage the symptoms? Where can I learn more? Please visit the UHN Patient Education website for more health information: University Health Network. All rights reserved. This information is to be used for informational purposes only and is not intended as a substitute for professional medical advice, diagnosis or treatment. Please consult your health care provider for advice about a specific medical condition. A single copy of these materials may be reprinted for non-commercial personal use only. Author: Dr. Sarah Ferguson, Dr. Doris Howell, Stephanie Bertin and the ELLICSR Research Team Created: 05/2013 Form: D-5767

2 After your cancer treatment, you may have symptoms of menopause. Your hormone levels may drop and you may stop having periods. You may have other symptoms as well. Women usually go through menopause in their late 40s to early 50s. However, some treatments for cancer can cause early menopause. In some cases, your periods may return. In other cases they will not. What causes menopause? Menopause happens when your ovaries make lower levels of hormones. The main hormones are estrogen and progesterone. At first your periods become irregular. When the level of estrogen is very low, your periods will stop completely. Some cancer treatments can cause early menopause as a side effect. This is called treatment-induced menopause. In this case, menopause may be temporary or permanent. It depends on the type of cancer treatment you had, and other factors. What are the symptoms of menopause? Each woman has a different experience of menopause. If your cancer treatment caused your menopause, you will have the same kind of symptoms. But, the symptoms may start more quickly. Here are some common symptoms of menopause. You may have all of these symptoms or only a few. Every woman is different. hot flashes night sweats problems sleeping, such as not being able to fall asleep weight gain vaginal dryness or vaginal itching some loss of bladder control more frequent bladder infections mood swings or getting easily irritated problems with memory and concentration 2

3 There are also long-term effects of menopause. These include: loss of bone mass or density, leading to osteoporosis changes in cholesterol levels and greater risk of heart disease Will my periods come back? Sometimes a menopause that starts after cancer treatment can be temporary. It depends on the type of cancer treatment you had, and other factors such as your age. If you had surgery Women who have surgery to remove both ovaries will go through menopause. If you had chemotherapy Some chemotherapy drugs can stop the ovaries from working normally. This can lead to menopause. Menopause may be temporary or permanent. This depends on many factors, such as: the type and dose of drug used how long your treatment lasted your age If you are close to the age of natural menopause, your menopause is more likely to be permanent. If you are younger, your periods may return after treatment. If you had radiation therapy to the pelvis Radiation therapy to the pelvis can affect your ovaries and lead to menopause. This depends on your age and the dose of radiation to the ovaries. The effect may be temporary or permanent. If you had hormonal therapy You may have some symptoms of menopause. For example, you may have changes in your periods and hot flashes. However this therapy does not bring on menopause. 3

4 What can help There are many things you can do to relieve your symptoms. Symptom What can help? hot flashes Wear light clothing in layers. Splash cool water on your wrists. Vitamin E supplements may help to ease hot flashes and improve sleep. Ask the doctor if this is right for you. Also ask how much you should take and how often to take it. Ask your doctor about medicines that can help with hot flashes. Some examples are: clonidine (Dixarit, Catapres) a drug used to treat high blood pressure venlafaxine (Effexor) an antidepressant paroxetine (Paxil) an antidepressant fluoxetine (Prozac) an antidepressant gabapentin (Neurontin) an drug used to prevent seizures Ask your doctor if these are right for you. Also ask about any side effects. sleep Try drinking warm milk or chamomile tea at bedtime. Avoid alcohol and caffeine, as they can make your symptoms worse. Exercise can help. Do regular physical activity during the day. This helps to lower stress and improves the way you feel. Try relaxation techniques before bed. continued on next page 4

5 mood swings or anxiety vaginal dryness bladder problems bladder problems (continued) Try relaxation techniques to lower your stress levels. Some examples are visualization, deep breathing, massage or yoga. A special type of counselling can be helpful. This is called cognitive behavioural therapy. Make sure you look for someone who is trained in this technique. Use a vaginal moisturizer that is water-based. Use a vaginal lubricator during sex. Having sex regularly may prevent dryness. To help prevent bladder infections: Drink lots of fluids. Empty your bladder often (especially after having sex). Wear cotton underwear. Keep your genital area clean. To improve bladder control, try Kegel exercises. These exercises use the same muscles that stop the flow of urine. If these muscles are stronger, you will have less leaking. You can do Kegel exercises while sitting, lying or standing: Try to draw in or tighten the muscles around the anus. Do not tighten your stomach, back or thigh muscles. Hold this squeeze for 10 seconds and then release slowly. Think of an elevator going up to the 10th floor and then coming back down. Repeat several times. Try to do a set of Kegel exercises every hour while awake. 5

6 What are herbal therapies? Some women choose to use herbal therapies to help with symptoms of menopause. We do not know how safe and effective these therapies are. There has not been enough research on the effects for women with cancer who are going through menopause. Some herbal products may interfere with treatments or may be harmful. Always check with your doctor before taking any herbal product. Some examples of herbal products: evening primrose oil ginseng black cohosh soy products Soy products contain weak plant estrogens (phytoestrogens). We do not know what effects these products have on women with certain types of cancer. What is hormone replacement therapy? Hormone replacement therapy (HRT) is sometimes used to help with severe menopausal symptoms. It can help to manage hot flashes, problems sleeping and mood swings. The therapy has benefits and risks, so it is important to discuss this with your doctor. Some women may choose this therapy if other treatments are not working for them. Hormones used: It is most common to take a combination of 2 hormones: estrogen and progestin. If you only take estrogen, you have a higher risk of getting cancer of the uterus. If your uterus was removed, then you can take estrogen on its own. 6

7 What are the benenefits of HRT? HRT can have a number of benefits: it helps reduce symptoms of menopause it protects against osteoporosis (losing bone density) it reduces the risk of colon cancer What are the risks of HRT? Taking estrogen and progestin for a long time increases the risk of: breast cancer heart disease stroke blood clots in the lungs Researchers now believe that taking these hormones for a long time has more risks than benefits. Making a decision with your doctor Talk to your doctor about the risks and benefits of HRT. Avoid taking these hormones unless your symptoms are severe and do not improve with other treatments. Many women feel that HRT is not a good choice for them. If you and your doctor decide that taking HRT is right for you: use the lowest dose take it for the shortest period of time possible 7

8 How do I talk to my doctor about my symptoms? To help you with your symptoms, you will get an appointment with your family doctor or a gynecologist. Prepare for your appointment, as it may be short. It can also be hard to remember everything you want to talk about. To prepare: 1. Keep track of your symptoms. For example, write down how many hot flashes you have in a day or week. Ask yourself: a. How severe are your symptoms? b. Does anything help? c. Does anything make them worse? 2. Make a list of any medications and vitamin supplements you take. Write down how much you take and how often you take them. 3. Prepare a list of questions to ask your doctor. List your most important questions first, in case time runs out. For your appointment: 1. Ask a family member or close friend to come along, if possible. You may get a lot of information at your visit. It can be hard to remember everything. 2. Take a notebook or notepad with you. Use it to write down important information during your visit. 3. Ask the questions you prepared. 4. Make sure you understand what your doctor is saying. To do this, you can: a. ask the doctor to repeat the information b. ask follow-up questions c. tell the doctor the main things you understood 8

9 What questions should I ask? What kind of tests might I need? What treatments can reduce my symptoms? Is there anything I can do to relieve my symptoms? What can I do to maintain my health? Do you have any printed information I can take with me? What websites do you recommend? What can I do to protect my health? See your family doctor regularly. Make sure the doctor: checks for signs of osteoporosis explains what you can do to reduce osteoporosis checks your cholesterol It also helps to have a healthy lifestyle. Where can I find more information? About Hormone Replacement Therapy: Canadian Cancer Society hormones/hormone%20replacement%20therapy.aspx?sc_lang=en About menopausal symptoms for women with breast cancer: MacMillan Cancer Support Livingwithbreastcancer/Menopausalsymptoms/Menopausalsymptoms. aspx 9

10 About menopause: The North American Menopause Society (NAMS) NAMS is a world leader in menopause information and education. It offers: a wide range of resources information that is easy to read publications such as the Early Menopause Guidebook Websites about cancer may also have information about menopause. Some examples are: American Cancer Society - groups for your specific type of cancer 10

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