Some cancer treatments can stop the ovaries working causing women to start their menopause earlier than expected. The ovaries produce the hormones oestrogen and progesterone, which control a woman’s monthly cycle (periods). Menopause naturally happens around the age of 50 when the ovaries stop producing these hormones and a woman’s periods stop.

Different cancer treatments can cause an early menopause:

• Surgery to remove both ovaries
• Chemotherapy
• Radiotherapy to the pelvis

Sometimes in younger women, chemotherapy causes a temporary menopause. The closer you are to your natural menopause the more likely it is to be permanent. Your cancer doctor and specialist nurse can explain more about this.

You may need blood tests to measure your hormone levels to find out if treatment has caused an early menopause.

This change in hormone levels can cause different menopause symptoms. Women may have one or more of these symptoms, and they can vary from mild to more severe:

• hot flushes and sweats
• vaginal dryness
• needing to pass urine more often
• a lower sex drive
• tiredness
• sleeplessness
• dry skin
• aches and pains
• mood swings
• loss of confidence and poor concentration.

Early menopause, may also cause other effects on the body. These include thinning of the bones (osteoporosis) and the risk of heart disease, which increases in women after menopause.

Infertility as a result of early menopause can be very difficult to deal with, especially if you wanted children or to add to your family. It can be particularly hard when you’re already coping with cancer.

Talking about your feelings with your partner (if you have one), family and friends, or your nurse or doctor may be helpful. If you feel you need more help you can talk to your doctor about a referral to a counsellor. The Daisy Network is a support group for women with premature menopause.

There are different ways to manage and reduce menopausal symptoms. Choosing the right approach for you will depend on different factors and your own preferences. Ask your cancer doctor and specialist nurse for advice. Your doctor can also prescribe drugs or treatments that can help reduce menopause symptoms.

Hormone replacement treatment (HRT)

Depending on the type of cancer, you may be able to take HRT to replace the hormones your ovaries are no longer producing. You can take HRT as a tablet, skin patch or an implant that you have every few months. HRT has benefits and risks so it’s important to talk it over with your doctor before you take it.

If you have a hormone related cancer doctors don’t usually advise HRT. Look under your cancer type for more information on this. But in other cancers when treatment causes an early menopause there’s often no reason why HRT can’t be prescribed. HRT can improve menopause symptoms and help to protect your bones and heart. Early menopause increases the risk of bone thinning and the risk of heart disease increases after menopause. Ask your cancer doctor if HRT is suitable for you.

If your doctor doesn’t recommend HRT for you or you don’t want to take it, there are different ways to manage menopause symptoms.

This is the most common menopausal symptom. Although the exact cause is unknown, body temperature control seems to be affected by falling oestrogen levels. Hot flushes can vary from a mild feeling of warmth in the face to more severe symptoms such as drenching night sweats that affect the whole body.

Hot flushes generally last for about 4–5 minutes. During a hot flush you may feel sudden warmth in your face, neck and chest, and you may become flushed and perspire. Some women feel their heart beating faster (palpitations) during a flush.

If you have flushes at night, these may affect your sleep. Night sweats can disrupt your sleep pattern, especially if you need to change your night clothes and bedding.

It’s difficult to completely stop hot flushes and sweats, but their frequency or intensity can often be reduced. Using a combination of some of the approaches below is often most successful at controlling or reducing flushes.

Be aware of triggers

Certain situations may bring on or trigger a hot flush. For example, getting too warm, drinking tea, coffee or alcohol, or eating spicy foods. Keeping a record of when you have flushes can help you find out what triggers them, so that you can try to avoid these triggers.

Even if you don’t have obvious triggers, keeping a record can help to measure how much a treatment for hot flushes is helping.

Practical tips

There’s lots of practical advice available to help women cope with hot flushes. Here are a few tips:

• Wear natural fabrics, such as cotton, and dress in layers, so you can remove clothes as needed.
• Use cotton sheets and have layers of bedding.
• Keep the room temperature cool or use a fan.
• Have cold drinks rather than hot ones.

Some women have found complementary therapies such as controlled breathing and yoga helpful.

Medicines

Drugs can be used for different reasons. Your doctor can prescribe drugs used to treat other health problems to help reduce the severity and frequency of your hot flushes and sweats.

Antidepressants - Antidepressants such as venlafaxine, paroxetine and fluoxetine can reduce the frequency and severity of hot flushes in some women. It generally takes 1–4 weeks for antidepressants to reduce hot flushes. Side effects of antidepressants can include headaches, feeling sick, reduced appetite, a dry mouth and constipation.

Gabapentin (Neurontin^®) - This is an anti-epilepsy drug that has been shown to be effective at reducing hot flush severity and frequency. Possible side effects include feeling very tired, drowsiness and dizziness.

Clonidine (Catapres^®, Dixarit^®) - Clonidine is a drug used to treat high blood pressure or migraines and may help reduce hot flushes and sweats in some women. It can take four weeks to work. Side effects can include constipation, a dry mouth and drowsiness.

The psychological effects of menopausal symptoms can be hard to cope with when you already have to deal with cancer.

These effects can include mood swings, a lack of confidence, and a loss of concentration and memory. At times you may feel very emotional or anxious.

Many women find it helpful to talk through their feelings with family and friends, or their doctor or nurse. A number of organisations provide support to women going through the menopause.

Some women may find counselling helpful. Your doctor or nurse can give you more advice.

Regular physical activity such as swimming or running or yoga may help to improve mood symptoms.

Having a low level of oestrogen can cause vaginal dryness and itching, and make having sex uncomfortable or painful. Some creams can be helpful when applied directly to the vagina (topical treatment).

Your doctor can tell you which product is most suitable for you. Your treatment should be regularly reviewed by your doctor, and you should tell them about any new symptoms. Some creams may damage condoms and diaphragms, so you may need to use another form of contraception to avoid pregnancy.

Non-hormonal creams

Replens MD® is a non-hormonal cream that you apply 2–3 times a week. The cream binds to the vaginal wall and helps rehydrate cells. It boosts blood flow in the vagina. Hyalofemme® is a newer cream that can be applied daily.

Water-based lubricants such as Senselle^®, KY-Jelly^®, Astroglide^® and Sylk^® can help reduce discomfort from vaginal dryness during sex.

Hormone-based treatments

Some treatments contain a small amount of oestrogen. Very little of the oestrogen is absorbed but if you have a hormone related cancer ask your cancer doctor if it’s safe for you to use. Vagifem^® is a tablet that you insert into the vagina (a pessary). You normally use it daily for two weeks, and then reduce the dosage to twice a week.

Ovestin^® and Ortho-Gynest^® can reduce dryness and itching for a short time. They’re available as creams and pessaries. They contain a small amount of oestrogen.

Estring^® is a vaginal ring that’s worn for three months. It slowly releases a small amount of oestrogen and may help reduce dryness.

A lower sex drive is a symptom of the menopause. HRT is usually the most effective treatment for this but isn’t usually recommended in women who’ve had breast cancer. A lower sex drive can also happen as a result of coping with the cancer and its treatments.

Other menopausal symptoms such as hot flushes and vaginal dryness can also reduce your interest in sex. Treating these may help to improve your sex life. Talk to your doctor or specialist nurse if you are having sexual problems as there may be treatments that can help, or they may be able to refer you to a sex therapist or counsellor.

You may pass urine more often, have some urine leakage or be more prone to urinary tract infections. 

It’s important to drink enough fluid each day (at least 2–3 pints/1.5 litres) to keep your bladder healthy. 

If you don’t drink enough, your urine will become concentrated and irritate the bladder. You’ll also be more likely to develop urinary tract infections. 

If you have problems with urine leakage, doing regular pelvic floor exercises (Kegel exercises) can help. These exercises strengthen the muscles that hold urine in the bladder. Your nurse or doctor can explain how to do these exercises, or you can order an instruction leaflet from the Bladder and Bowel Foundation. 

Speak to your doctor if you develop symptoms of a urinary tract infection. Symptoms include cloudy or smelly urine, and pain or discomfort when passing urine.

You may have difficulty sleeping because of hot flushes, sweats or anxiety. The following suggestions may help you to relax and sleep well: 

• A warm drink, brushing your teeth or reading in bed for a while can let your brain know that it’s time to sleep. 
• Sleep for the right amount of time without oversleeping – too much time in bed can affect the quality of your sleep. Also, wake up and go to bed at the same time each day. 
• Get out of bed if you can’t sleep, and try reading, or listening to some soothing music. Wait until you feel tired again, and then go back to bed. 
• Breathing exercises and relaxation techniques, or listening to relaxation CDs, or podcasts, can help reduce anxiety and sleeplessness. Your GP can prescribe sleeping tablets for a short period of time – these may help you re-establish a sleep pattern. 
• Regular physical activity may help improve with sleep problems.