What is the menopause?
The menopause usually occurs between the ages of 45 and 55 years, with 51 being the average. However, some cancer treatments, such as removal of ovaries, chemotherapy, radiation and hormonal therapy can result in an early menopause or menopausal symptoms. The menopause happens when a woman’s ovaries stop releasing eggs. The ovaries are the main source of the hormone estrogen, and as a result, there is a drop of the levels of estrogen in the body.
Hormones are important for regulating most major bodily processes, so a hormonal imbalance can affect a wide range of bodily functions.
Your ovaries are the source of estrogen and progesterone, the two key hormones that control the reproductive system, including the menstrual cycle and fertility in women. You are born with all the eggs you will ever have. The eggs are in the follicles, which are found in the ovaries. During menopause, the number of ovarian follicles declines and the ovaries become less responsive to the two other hormones involved in reproduction—Luteinizing Hormone (LH) and Follicle-Stimulating Hormone (FSH).
As your ovaries age and release fewer hormones, FSH and LH can no longer perform their usual functions to regulate your estrogen, progesterone and testosterone. These inevitable changes in your hormones and natural decline of estrogen levels can bring on a combination of hormonal and biochemical fluctuations that can lead to changes in your body, brain and nervous system. …. the menopause!!
How does it affect women?
The first most women notice is a change to their periods, they may become unpredictable in terms of regularity, length and flow. This can begin up to 8 to 10 years before menopause, usually in a woman's 40s, but can start in her 30s or even earlier. This stage is called the perimenopause and is when the ovaries gradually begin to make less estrogen and many women experience menopausal symptoms. Women who are still having menstrual cycles during this time can still get pregnant.
The menopause is classified as having started when a woman stops having periods for a one year and is no longer able to get pregnant.
With surgical menopause, menopause occurs abruptly on the day of surgery. With treatment induced menopause, such as cancer drugs, there may be a shorter transition than normal as the damaged ovaries shut down production of hormones over a period of time. The abrupt loss of ovarian hormones can cause more drastic symptoms than those seen with a natural menopause.
If you are about to undergo treatment, speak to your medical team so you know what to expect and how to prepare.
Common symptoms associated with the perimenopause:
periods that are heavier or lighter than normal
worse PMS before periods
increase in heartbeat
loss of sex drive
urinary tract infections
fertility issues (in women who are trying to conceive)
Common symptoms associated with the menopause:
As estrogen levels drop, women may start experiencing symptoms of menopause. Some of these can occur while you are still at the perimenopause stage:
Hot flushes and sweats
A sudden feeling of heat that seems to come from nowhere and spreads throughout the body. You might also experience sweating, palpitations, and flushing of the face which can make your skin red and sweaty
A change in your hormone levels can affect how much vaginal discharge or fluid you have, which may cause pain, itching or discomfort during sex
Often linked to relationship issues, stress or tiredness, but can also be due to reduced hormone levels
Often caused by hot flashes, it can leave many menopausal women tossing and turning or waking up drenched in sweat. The next day you may be more irritable, anxious and have trouble concentrating
Aches and pains
Achy, swollen joints are another common symptom of menopause. No one knows for sure why, but one theory is that as estrogen levels decline, the joints swell and become painful
Mood swings and irritability
According to an article in Medical News Today up to 70 percent of women describe irritability as their main emotional problem during the early stages of the menopausal transition. Depression also becomes more common, affecting up to 1 out of every 5 women
Many women experience tension, nervousness, worry, and panic attacks during menopause. Some may find their anxiety getting worse while others may develop it for the first time.
Loss of bone density
Women also lose bone rapidly in the first few years after the menopause (when monthly periods stop and the ovaries stop producing an egg), putting them at risk of osteoporosis, particularly if the menopause begins early (before the age of 45)
According to the North American Menopause Society, collagen loss begins early but is most rapid in the first few years of menopause, leading to dry, flaky skin and lacklustre locks. ... “When estrogen levels drop during menopause, the skin gets more wrinkled and drier, and in some women, it can even be itchy.”
It's common for women in menopause to lose control of their bladder. You may also feel a constant need to urinate even without a full bladder or experience painful urination. This is because during menopause, the tissues in your vagina and urethra lose their elasticity and the lining thins.
Please note that symptoms from cancer treatment are often very similar to menopause symptoms – so it’s easy to get confused. If you are already experiencing peri-menopausal or menopausal symptoms prior to your cancer treatment it can sometimes be hard to distinguish whether you are suffering from chemo side affects or menopausal symptoms or both. If in doubt, ask your medical team - they will be able to run a simple test to find out.
Will cancer treatment bring on the menopause?
As we’ve already mentioned, in women prior to the menopause, some cancer treatments may stop the ovaries working and cause an early menopause. Other treatments won’t cause an early menopause but may cause the symptoms associated with it.
If you are younger, the treatment induced menopause may be temporary, and over-time your ovaries will start to produce eggs again. However, if you are close to your natural menopause, the menopause is more likely to become permanent.
Talk to your doctor about this before treatment, especially if your fertility is a concern. There are a number of options available that may preserve your fertility and increase the chance of you having your own children in the future including:
- fertility preservation procedures – freezing embryos (IVF), eggs or ovarian tissue – before starting treatment
- protecting the ovaries during chemotherapy
Find out in the next blog how you can relieve symptoms of menopause.
If you've been affected by menopause and have any questions, or want to share your experiences with others, join the Facebook Chemotherapy Support Group where you'll find thousands of people ready to office advice and support.