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Early menopause and HRT
The menopause
The word ‘menopause’ refers to a woman’s final menstrual
period. It is also commonly used to describe the time during
which a woman’s body is changing in preparation for the
menopause, otherwise known as ‘the peri-menopause’ or ‘the
change of life’. Women usually go through the menopause
between the ages of 45 and 55, but it can start as early as 40
or as late as 60 years of age. The changes leading up to your
final period may last a few months or several years, and it’s
unlikely that your periods will just suddenly stop [1]. Instead,
some might be missed or late, and they might become
heavier and more painful before stopping completely. A
woman is classed as being postmenopausal when she has
had no menstrual periods for 12 months.
During the menopause, the levels of key hormones
(oestrogen and progesterone) needed for menstruation and pregnancy start to fall, and in
some women this triggers a variety of menopausal symptoms. These may last for a few
months or several years. Your risk of osteoporosis (bone thinning) also increases when
hormone levels drop during the menopause. There are treatments that can help, and your
doctor will be able to advise on which might be best for you.
Going through the menopause means that you will no longer be able to have children
naturally. But there are now a number of options that you can discuss with your doctor that
aim to preserve your fertility while you are being treated for cervical cancer. If you think you
might want to have children in the future, you should speak to your doctor about the
possibility of freezing your eggs, creating (through in vitro fertilisation) and freezing embryos,
and freezing your ovarian tissue.
Cervical cancer and early menopause
Some treatments for cervical cancer can trigger the menopause. Pelvic radiotherapy, for
example, affects the ovaries and this can sometimes bring on the menopause, usually about
three months after the treatment starts. And if both ovaries need to be removed during
surgery, your body enters the menopause immediately after the operation. If one or both of
your ovaries are left intact, it’s possible that you will go into the menopause earlier then you
otherwise might have.. If these treatments cause you to enter the menopause before the age
of 45 years, you are classed as being in ‘Early Menopause’.
How is an early menopause different to a natural menopause?
During a natural menopause, your levels of oestrogen and progesterone fall gradually,
menstrual periods become less frequent, and you will tend to have mild or moderate
menopausal symptoms that build up over time. If you enter early menopause because of
Jo’s Cervical Cancer Trust website review: Early enopause and HRT v0.3 – Jo’s Voices review 12.13
treatment for cervical cancer, your hormones drop more quickly, your periods stop sooner
and you will probably experience strong menopausal symptoms straight after treatment [2].
Jo’s Cervical Cancer Trust website review: Early enopause and HRT v0.3 – Jo’s Voices review 12.13
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Symptoms of the menopause
All women will have a different experience of the menopause. Some will barely notice any
symptoms while others will need medications to help them cope. There are a wide range of
possible symptoms, but the most common are hot flushes and night sweats. Common
symptoms include:
 Hot flushes, sweats and sometimes palpitations
 Insomnia (difficulty sleeping)
 Low mood
 Mood swings and irritability
 Lowered sex drive (libido)
 Dry skin, hair and nails
 Bone thinning (osteoporosis)
 Vaginal dryness and pain during sex
 Psychological effects such as poor memory, loss of confidence and low self esteem
 Passing urine more often and increased risk of urinary infections
 Breast changes
 Aches and pains
Jo’s Cervical Cancer Trust website review: Early enopause and HRT v0.3 – Jo’s Voices review 12.13
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Managing the menopause
The symptoms of the menopause will pass, but this may take a
couple of years. If they are troublesome, hormone replacement
therapy (HRT) can relieve many of the symptoms of
menopause for most women. This is because HRT replaces
the hormones that your body is no longer producing. Other
medicines that might help are: anti-depressants (these can be
called selective serotonin receptor inhibitors (SSRIs)),
gabapentin, clonidine, selective oestrogen receptor modulators
(SORMs) and bisphosphonates [3]. Your doctor will be able to
advise on whether or not these are suitable for you.
Complementary therapies and supplements (vitamin E,
evening primrose oil, and plant oestrogens such as black
cohosh, red clover, soybeans and flaxseed) might also help
relieve symptoms [4]. If you do favour the more natural approaches, please seek advice
from a qualified practitioner and also discuss your thoughts with your doctor to make sure
these therapies will be safe for you. Plant oestrogens, for example, might not be safe for
some women who have had breast cancer.
You can also help relieve your symptoms by adopting a healthier lifestyle. Regular exercise
will help alleviate emotional and psychological symptoms, and weight-bearing exercise
(exercise that puts pressure on your bones; for example, walking, jogging and cycling) can
help protect against osteoporosis. It’s also thought that certain triggers - alcohol, spicy foods,
caffeine and smoking - can provoke hot flushes, so you may want to cut down on these [3].
Managing pain during sex and loss of libido
Surgery and radiotherapy to the pelvic area can cause vaginal dryness, and make your
vagina shorter, narrower and less stretchy. The skin inside the vagina can also become so
delicate that it tears easily. If, after having these treatments, sex becomes uncomfortable or
painful, you may need to use vaginal dilators - cone shaped objects that you put into your
vagina to help stretch it. You can also try to gently stretch your vagina through sexual
intercourse (if this is possible and not too painful), or using your fingers or a vibrator. You
may be able to use vaginal oestrogen - oestrogen in a cream, ring tablet or pessary that you
put into your vagina about twice a week. And you can also buy creams and lubricants that
you put into your vagina just before you have sex. Don’t be embarrassed to ask for advice,
this is a very common problem.
Download: Best practice guidelines on the use of vaginal dilators in women receiving pelvic
radiotherapy
After treatment for cervical cancer, you may not feel in the mood for sex. This is quite normal
after treatment for any type of cancer as your body and emotions will be in turmoil. There
may be an added factor for women who’ve been treated for cervical cancer – if your ovaries
are removed or damaged during treatment, the fall in your hormone levels may cause you to
Jo’s Cervical Cancer Trust website review: Early enopause and HRT v0.3 – Jo’s Voices review 12.13
lose interest in having sex. If you are in a relationship it will be important to discuss how
you’re feeling about sex with your partner. Together you should be able to work out what is
best for you both so that you can continue to show each other affection and feel loved. If loss
of sexual desire is a problem, your doctor might suggest combining HRT with testosterone,
although it is still not certain how helpful these are or how safe they are in the long term. If
you are worried about your sex life you may want to talk through how you feel with a
counsellor or therapist, see our links section: http://www.jostrust.org.uk/links/links/emotionaland-mental-support.
Managing infertility
Going through the menopause means that women become unable to have children naturally.
This loss of fertility can be upsetting even if you’ve had a family or did not intend to have
children. It can also be particularly hard to deal with if you’re going through early
menopause, and have not yet had the children you wish to have. It will be important for you
to discuss your feelings around infertility with your partner so you can support each other
through this difficult time. If you would like to talk to someone outside your own friends and
family, you may be interested in counselling ;
http://www.jostrust.org.uk/links/links/menopause-hysterectomy-and-hrt.
Jo’s Cervical Cancer Trust website review: Early enopause and HRT v0.3 – Jo’s Voices review 12.13
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HRT
HRT (hormone replacement therapy) involves taking female sex hormones to replace
hormones that your ovaries no longer produce after menopause. HRT is very effective in
easing many of the symptoms of menopause that women have [5]. It can also help to lower
the risk of osteoporosis [6] and prevent some long term health problems associated with
early menopause
There are two main types of HRT. One type contains only oestrogen and is called ‘oestrogen
only HRT’ and is used for women who have had a hysterectomy The other contains
oestrogen and a progesterone – both of the female sex hormones – and is called ‘combined
HRT’ and is used if you still have a womb. In addition to these, there are other hormone
therapies, such as progestogens and testosterone [3].
There are several ways HRT can be taken, including as a gel that you rub into your skin,
tablets (some taken by mouth and some inserted into the vagina), a patch that sticks onto
your skin, and an implant placed under your skin. Deciding which type of HRT to use can
be difficult. Your GP or specialist will be able to advise on which type of HRT is most likely to
relieve your symptoms, although you may need to try several different types to find one that
really suits you.
Side effects
Some women do get side effects with HRT and these will be explained if you choose to use
HRT, Usually they are short lived or managed by a simple change of treatment.
Risks
Some women are wary of HRT because it has been reported in the media that it can
increase your risk of developing cancer. There is no evidence that HRT or vaginal oestrogen
after treatment for cervical cancer, stimulate your cervical cancer to grow again [5]. (It is
currently being debated whether or not taking HRT can increase your risk of ovarian and
breast cancer, and it is generally accepted that oestrogen-only HRT can increase your risk of
womb cancer.) [7; 8]. If you are worried about taking HRT, you should discuss the risks and
benefits relating to your individual situation with your doctor. For most women with
menopausal symptoms, the benefits of taking HRT outweigh the risks.(7)
It’s important to remember that if you are in early menopause (ie under 45) rather than
natural menopause, HRT will just be replacing the hormones that would normally be
produced at your age. Because of this, it is thought that most women in early menopause
would benefit from taking HRT at least until the predicted age of natural menopause –
roughly 52 years of age [7].
Jo’s Cervical Cancer Trust website review: Early enopause and HRT v0.3 – Jo’s Voices review 12.13
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How you might feel during this time
Even if you had discussed the possibility of
early menopause with your doctor before
treatment, it can still be a shock when it
happens. Dealing with the actual treatment
for cancer is a challenge in itself, and having
to deal with strong menopausal symptoms at
the same time can be overwhelming. You
may feel mixed emotions. Many women feel
anxious about what will happen to them as
part of the menopause. Others are angry, sad
or worried, and some are not bothered
because it’s something that happens to all women.
Each woman’s experience of menopause is different and many women have only mild
symptoms. For some women though, the severity of their menopausal symptoms comes as
a shock and is emotionally and physically draining. Symptoms will ease over time, but in the
meantime it’s important to remember that there are treatments that can help you and also
specialists who can help you deal with the different symptoms. Your hospital may even have
a specialist menopause clinic for women in your situation.
Losing the ability to have children naturally can provoke strong emotions in women. Even if
you did not intend to have children or have already had the children you wanted, the loss of
fertility can be very upsetting. (You may feel you have lost a part of yourself and are less
feminine, and this may affect your self confidence)You may feel very sad or angry that the
treatment has changed your body.
If you’ve not yet had the children you wish to have, going through early menopause can be
particularly hard to deal with. The sudden withdrawal of your ability to have children might
elicit strong emotions similar to a bereavement. You may also find it difficult to socialise with
friends who are starting their own families.
All this is natural and it will take time for you to come to terms with infertility. you may need
help and support from a professional. You may find our support services useful – these
enable you to talk to others who are going through similar experiences.
For organisations that can provide more information on the menopause and HRT, click here
for our links: http://www.jostrust.org.uk/links/links/menopause-hysterectomy-and-hrt .
For more information on fertility and loss of fertility, click here for our links:
http://www.jostrust.org.uk/links/links/fertility-and-infertility
Jo’s Cervical Cancer Trust website review: Early enopause and HRT v0.3 – Jo’s Voices review 12.13
References
1. Kronenberg F (1994) Hot flashes: phenomenology, quality of life and search for
treatment options. Experimental Gerontology, 29(3/4):319–336
2. Hinds L and Price J (2010) Menopause, hormone replacement and gynaecological
cancers. Menopause International 16 (2) , 89-93.
3. Dunleavey R (2009) Cervical Cancer: A Guide for Nurses. Wiley-Blackwell
4. Dennehy C (2006) The use of herbs and dietary supplements in gynecology: an
evidence-based review. Journal of Midwifery Women’s Health, 51 (6), 402 – 409
5. Singh P and Oehler MK (2010) Hormone replacement after gynaecological cancer.
Maturitas, 65, 190-197
6. Challberg J et al. (2011) Menopausal symptoms and bone health in women
undertaking risk reducing bilateral salpingo-oophorectomy: significant bone health
issues in those not taking HRT. Br J Cancer;105:22–7
7. Panay N et al (2013) The 2013 British Menopause Society & Women’s Health
Concern recommendations on hormone replacement therapy. Menopause
International,19(2) 59–68
8. Marjoribanks J et al (2012) Long term hormone therapy for perimenopausal and
postmenopausal women. Cochrane Database of Systematic Reviews 2012, Issue 7.
Art. No.: CD004143
Jo’s Cervical Cancer Trust website review: Early enopause and HRT v0.3 – Jo’s Voices review 12.13