Menopause and Cancer

An article by Dani Binnington, Founder:

Although the menopause conversation, particularly in the UK, has boomed over the last few years, women with a history of cancer have felt very much excluded from it all. 
Women took to social media, TV and the press, to educate and share their experiences. There was very much what felt like a lightbulb moment for so many and before you knew it treatment options such as hormone replacement therapy were on everybody’s lips. Alongside that a real sense of ‘togetherness’ could be felt. Women had been ignored by science and medicine for too long! The mis-reporting of data had meant that women in perimenopause and menopause were offered hardly any, or inadequate treatment options to their sleepless nights, anxiety, hot flushes, itchy skin, dray vaginas, loss of libido and numerous other very much quality of life-impacting symptoms. When we then discovered that even our own Dr’s had absolutely zero mandatory training of the menopause – when every other patient is a woman – all hell broke loose. A much needed ‘menopause revolution’ as many called it was underway.

What about women with a history of cancer?

But whilst all of this was happening I could not help but think “What about me? What about us? What about women with a history of cancer who also struggle with the menopause? What are our treatment options?”
I was 33 when I was diagnosed with breast cancer and my menopause was onset by surgery at the age of 39. I knew managing surgically onset menopause would come with challenges, but I was dumbfounded when I could not find any information, not even on my usual trusted sites of big charities or any of the world’s menopause societies on how to manage this.
Whilst HRT was on everyone’s lips, all I could find were statements that it was contraindicated for women after cancer – and no other option or word of advice was offered. Talk about medical gaslighting.

In one of our recent surveys in collaboration with University College London Hospital we found that:

• 90.4% of the women surveyed entered menopause as a direct result of their cancer treatment.
• 77% said that they received no or inadequate help in managing their menopausal symptoms.
• A staggering 92% feel isolated in their experiences – and that’s at a time when an army of women was engaging in the so-called ‘menopause revolution’.

Well, let me tell you – in my eyes this is only a revolution if we make it all-inclusive!

Cancer treatments can put women into menopause by impacting ovarian function and reducing the production of hormones. Yet, we know that women feel very much under-prepared for what’s to come. In our survey, 71% said they had no idea of the significant impact that menopause would have on them.

The treatments that are most likely to induce menopause in women include:

1. Chemotherapy: Many chemotherapy drugs are designed to target rapidly dividing cells, which include both cancer cells and healthy cells in the ovaries. As a result, chemotherapy can lead to ovarian damage and dysfunction, causing menopausal symptoms. This can be either temporary or permanent. It is upsetting for people when they don’t know if their periods will come back or not.
2. Radiation therapy: Radiation therapy may be used to treat cancer in or near the pelvic region. Depending on the location and intensity of the radiation, it can damage the ovaries and result in ovarian failure.
3. Hormone therapy: Some cancer treatments, such as hormone therapy for breast cancer, work by blocking or suppressing the production of oestrogen. This can cause menopausal symptoms and, in some cases, lead to premature menopause.
4. Surgery: Women may undergo surgical removal of one or both ovaries. This can lead to immediate menopause.
5. Targeted therapies: Certain targeted therapies may have an impact on hormonal regulation, potentially causing menopausal symptoms.

Addressing menopause and its impact on individuals with cancer should be an integral component of standard cancer care services.

It appears counterintuitive that our healthcare protocols facilitate inducing menopause in women without a comprehensive plan to support them through this transition.

When menopause after cancer remains un-addressed:

When menopause remains unattended, the considerable adverse physical, mental, and emotional consequences it can entail may make post-cancer recovery appear insurmountable. Prolonged, unexplained, and often debilitating symptoms that persist and worsen over the years following one’s initial cancer diagnosis can leave patients feeling isolated and unsupported by their medical teams.
This can lead individuals to question whether something is inherently wrong with them and whether enduring these challenges is their only option. For some, it may even feel like a perceived trade-off for having successfully battled cancer. Physically, untreated menopause symptoms can pose numerous health risks for women and give rise to future health concerns.
I have met many people who say that managing menopause after cancer is harder than chemotherapy, radiotherapy and surgery all together.
Almost all feel there is nothing much they can do and putting up with it is the only choice they have.

But this is not true.
I have devoted my time and enthusiasm to establish the Menopause and Cancer Community Interest Company, with the aim of demonstrating to individuals that they have choices, providing them with a sense of belonging, and actively contributing to spurring broader changes. A clear focus for us is to collaborate closely with NHS services, striving to educate healthcare professionals who are at the forefront of patient care, and making a significant impact at the critical junctures in a patient’s journey.

Managing menopause following a cancer diagnosis necessitates a comprehensive strategy.

It will require analytical thinking, research, troubleshooting especially when hormone replacement therapy is not an option.

Adopting a multifaceted approach and employing a diverse range of strategies is often the most effective way to address these challenges. It’s essential to remain open-minded because just as our symptoms change over time, our preferences and strategies also can evolve over time, and flexibility is key in optimising the management of menopause after cancer.

Survivors have access to a range of essential tools for managing menopause, and we provide comprehensive guidance in our work on how to utilise them effectively:

1. Non-Hormonal prescribable Medications: Some non-hormonal medications, like selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs), can be used to manage symptoms like hot flushes and mood changes. Alongside these there are other prescribable options that can be very helpful and must not be dismissed.
2. Hormone Replacement Therapy (HRT): HRT, such as oestrogen and progesterone, can help alleviate menopausal symptoms. However, it may not be recommended for all cancer survivors, especially those with hormone-sensitive cancers.
3. Vaginal Moisturisers and Oestrogen: For women experiencing vaginal dryness or discomfort, vaginal oestrogen treatments is an option as they have minimal systemic absorption and are considered safe for most cancer survivors. The correct use of vaginal moisturisers, lubes and washes can make a big difference too.
4. Lifestyle Changes: Adopting a healthy lifestyle can help manage menopausal symptoms. This includes maintaining a balanced diet, regular exercise, stress reduction, and avoiding triggers like caffeine and alcohol. This toolbox is crucial and will support all other strategies. It is more difficult to implement a new routine and create new habits but this can be transformative.
5. Complementary Therapies: Therapies such as acupuncture, yoga, herbal medication, Cognitive Behaviour Therapy, Cognitive Behaviour Therapy for Insomnia and mindfulness meditation have plenty of evidence behind them.
6. Supportive Care: Counselling or support groups can be beneficial for managing the emotional and psychological aspects of menopause after cancer.

At Menopause and Cancer, we are passionate about helping women understand that they can actively fork out an action plan for themselves and help them understand that they can draw upon many of the above strategies.

We offer various support services to do so:

• We are proud to host the world’s only The Menopause And Cancer podcast which is in the top 1.5% of all podcasts worldwide.
• We host the Private Facebook hub, a safe community on Facebook. The strength of belonging to a compassionate and encouraging community, combined with understanding our available choices, can be genuinely transformative.
• We host online and in-person workshops, programs, yoga classes and retreat days. These can be found here.
• All of our work is expert-led by either British Menopause Society accredited menopause specialists or other experts in their fields.

I hope that the resources available on our website, in conjunction with our services, will serve as valuable tools for both patients and professionals, aiding them in navigating and supporting the menopausal journey following a cancer experience.

No matter the type of cancer you’ve faced.No matter the stage of your cancer journey.
Regardless of how menopause was triggered for you.
Irrespective of your age or ethnic background.
Whether you identify as a woman or otherwise.

We are here for you.