Menopausal Treatments after Early Menopause or Cancer

There is much fear and misinformation regarding MHT and breast cancer. Adding to this confusion, having some cancers – or treatments to prevent them – might actually be a reason to use estrogen therapy. 

By Sally Stankovic and Dr Kelly Teagle

Treating menopausal symptoms after early menopause or breast cancer requires a tailored approach. Hormonal treatment is not the answer for everyone; for example, if you’ve had breast cancer it would not usually be recommended but your symptoms can be managed with other specific treatments.

On the other hand, if you’ve experienced an early menopause (regardless of the cause) then MHT (Menopausal Hormone Therapy) may be a low-risk, effective symptom treatment with important long-term protective benefits. Let’s explore the options…

What is Early or Premature Menopause?

“Early menopause” generally refers to menopause under the age of 45, whilst “premature menopause” or “primary ovarian insufficiency” (POI) refer to the cessation of menstruation and reproductive function before the age of 40. These conditions can occur naturally or be induced by medical and surgical
treatments, or due to other factors such as:

• Natural Causes: Some women may experience early menopause due to genetic factors or unknown reasons, where the ovaries stop producing normal levels of hormones.
• Medical Treatments: Cancer treatments like chemotherapy or radiation therapy can damage ovarian tissue, leading to premature menopause.
• Surgical Procedures: Surgical removal of both ovaries (bilateral oophorectomy) for medical reasons can induce early menopause, eg. risk reduction for women with BRCA gene mutations.
• Autoimmune Conditions: Certain autoimmune diseases can affect the ovaries and lead to premature ovarian failure.

Symptoms of Early Menopause

The symptoms of early or premature menopause are similar to those of natural menopause, which may include hot flushes, night sweats, vaginal dryness, mood swings, and decreased libido. These symptoms can be more severe and long-lasting however in cases of an early and/or sudden decline of estrogen.

Potential Consequences of Early Menopause

The average age of menopause in Australia is 51. However if you are much younger than this at menopause you may be subjected to many more years of low estrogen than “average” women. This puts you at increased risk of premature osteoporosis and heart disease, as well as mood disorders and dementia.

For this reason, it’s critical that women who experience menopause (from any cause) before age 45 get expert advice about treatments that might be needed to reduce their risk.

Managing the Symptoms of Early Menopause

Managing menopause symptoms always involves a combination of medical and psychological strategies, as well as lifestyle adjustments.

Menopausal Hormone Therapy (MHT): MHT can work very well for women with early or premature menopause by replacing lost estrogen and progesterone, which helps to prevent bone loss and cardiovascular disease. However it’s crucial to discuss individual risks and benefits with healthcare providers, especially for women who’ve had cancer. For example, MHT is generally not considered a good option after breast cancers yet can be quite ok after certain types of ovarian cancers (but not others).

If you have concerns that MHT might increase your risk of developing breast cancer, this article may help to alleviate some concerns: “Does Hormonal Therapy Cause Breast Cancer?”

Non-Hormonal Medical Therapies: Some antidepressants can help manage hot flushes and mood swings without affecting estrogen levels, so they are a great choice if you’ve had a hormone sensitive cancer. They can also relieve mood symptoms at the same time.

Gabapentin or Pregabalin, often used for nerve-related pain, can also reduce hot flushes. There is also good evidence for the effectiveness of clonidine or oxybutynin on vasomotor symptoms (flushes and sweats); these are also used for high blood pressure and urinary frequency respectively. Details of these treatments can be found in the Australasian Menopause Society’s factsheet “Nonhormonal Treatments for Menopause Symptoms.”

Vaginal Estrogen, Moisturisers and Lubricants: Vaginal Estrogen: Low-dose vaginal estrogen (in creams or pessaries) can improve vaginal dryness and discomfort with limited systemic absorption, so they are generally considered low risk even for most breast cancer survivors.

It’s super important to also use good vaginal lubricants and moisturisers to prevent damage or pain to the delicate vulvovaginal tissues.

Bone Health: Early menopause increases the risk of osteoporosis, so a baseline bone density scan is a great idea. There is a Medicare rebate if you have early/premature menopause or prolonged loss of periods other than pregnancy.

To offset this increased risk you can use calcium and vitamin D supplements, weight-bearing exercise, strength and impact training to support bone health, but always discuss with a trusted healthcare provider before starting any new interventions.

Cardiovascular Health: A baseline health check with your GP including blood pressure, cholesterol and fasting blood sugars can help establish your pre- existing risk level. Lifestyle modifications such as regular exercise, healthy diet and avoiding smoking can reduce cardiovascular risks associated with early menopause.

Psychological Support: Counselling or support groups can address emotional challenges and fertility or body image concerns associated with cancer treatment and early or premature menopause.

Lifestyle after Early Menopause or Cancer

After early menopause or cancer treatment a healthy lifestyle is hugely important for future health and well-being, and reduces the risk of future cancers.

Physical Activity: You may be tired of hearing it, but that doesn’t make it less true! Regular exercise helps improve fitness and mood, reduces fatigue and lowers the risk of further cancers. Regular vigorous exercise also reduces dementia risk enormously.

Healthy Diet: We’re all prone to a naughty snack here and there, so let’s focus the rest of the time on a balanced diet rich in fruits, vegetables, whole grains, and lean proteins. Limit processed foods and sugars. A Mediterranean diet is anti-inflammatory and proven to reduce the risk of cardiovascular disease and early death in women by over 20%.

Limit Alcohol Consumption: Limit alcohol intake to no more than one drink per day, as alcohol consumption is also linked to an increased risk of breast cancer recurrence.

Quit Smoking: Do your best. Smoking is associated with various health risks, including cancer and cardiovascular disease.

Manage Stress: Probably the hardest one of all. Life is busy for all of us. We’re rushing about between work, family and other commitments, and if we stack up worry and stress on top of it all, something’s gotta give; don’t let it be your health! Practice stress-reducing techniques such as exercise, meditation, deep breathing, hobbies or yoga. Think of it as a necessity, not a luxury.

Regular Check-Ups: Attend regular health appointments for monitoring and screening. If you still have breast tissue, perform regular breast self-exams and attend mammograms or other imaging tests as advised by healthcare providers.

Emotional Support: Seek emotional support from family, friends, support groups or counselling services to cope with emotional challenges and anxiety related to cancer survivorship.

Quality of Life Matters

Ultimately it all comes down to understanding the risks and benefits of various treatment options to make informed choices for your own health. If you’re considering MHT, are the potential risks outweighed by improvements in quality of life and reduced risk of cardiovascular disease, diabetes and osteoporosis? It’s a decision that only you can make, after careful consideration and discussion with your doctor.

There’s no “one size fits all” solution for menopausal symptoms in women who’ve had cancer. Speak to a health professional who has good knowledge about menopause treatments for an individualised treatment plan.

What is WellFemme About?

If you can’t find the professional help you need for your menopause or perimenopausal symptoms then book a Telehealth consultation with an expert WellFemme menopause doctor.

WellFemme is Australia’s first dedicated Telehealth menopause clinic, servicing locations nationwide including: Melbourne, Sydney, Adelaide, Darwin, Perth, Hobart, Brisbane, Dubbo, Bendigo, Broken Hill, Broome, Alice Springs, Launceston, Cairns, Mildura, Lightning Ridge, Kalgoorlie, Albany, Toowoomba, Charleville, Port Headland, Katherine, Ballarat, Coober Pedy, Bourke, Albury… and your place! 🙂