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«Breast cancer and early menopause a guide for younger women Breast cancer and early menopause a guide for younger women Breast cancer and early ...»

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Breast cancer

and early menopause

a guide for younger women

Breast cancer

and early menopause

a guide for younger women

Breast cancer and early menopause — a guide for younger women

First edition published in 2008 by:

National Breast and Ovarian Cancer Centre*.

Third edition published in 2013 by:

Cancer Australia

Locked Bag 3, Strawberry Hills NSW 2012

Tel: 61 2 9357 9400 Fax: 61 2 9357 9477 Freecall: 1800 624 973 Website: www.canceraustralia.gov.au © Cancer Australia 2013 ISBN Print: 978-1-74127-252-9 Online: 978-1-74127-253-6 CIP: 616.99449 This work is copyright. You may reproduce the whole or part of this work in unaltered form for your own personal use or, if you are part of an organisation, for internal use within your organisation, but only if you or your organisation do not use the reproduction for any commercial purpose and retain this copyright notice and all disclaimer notices as part of that reproduction. Apart from rights to use as permitted by the Copyright Act 1968 or allowed by this copyright notice, all other rights are reserved and you are not allowed to reproduce the whole or any part of this work in any way (electronic or otherwise) without first being given the specific written permission from Cancer Australia to do so. Requests and inquiries concerning reproduction and rights are to be sent to the Publications and Copyright contact officer, Cancer Australia, Locked Bag 3, Strawberry Hills NSW 2012.

Copies of this report can be downloaded from the Cancer Australia website: canceraustralia.gov.au.

Recommended citation:

Cancer Australia. Breast cancer and early menopause — a guide for younger women. Cancer Australia, Surry Hills, NSW, 2012.

Disclaimer:

Cancer Australia does not accept any liability for any injury, loss or damage incurred by use of or reliance on the information. Cancer Australia develops material based on the best available evidence, however it cannot guarantee and assumes no legal liability or responsibility for the currency or completeness of the information.

* On 30 June 2011, National Breast and Ovarian Cancer Centre (NBOCC) amalgamated with Cancer Australia to form a single national agency, Cancer Australia, to provide leadership in cancer control and improve outcomes for Australians affected by cancer.

Contents Acknowledgements

Foreword

Who this booklet is for

How to use this booklet

Introduction

Summary

What is menopause?

Hormone production and menopause

Younger women and menopause

Menopause and breast cancer

Summary

Breast cancer treatment and menopause

Why do breast cancer treatments cause menopause?

Which breast cancer treatments cause menopause?

How is menopause diagnosed?

How do I know if I am experiencing menopause?

How long will menopause symptoms last?..

Effects of breast cancer treatments on fertility

Managing menopausal symptoms

Summary

Managing menopause

Coping with stress and emotional worries

Mood changes

Hot flushes and night sweats

Sexuality and libido

Insomnia and disrupted sleep

Bladder problems

Fatigue and tiredness

Effects on memory

Bone and joint pain

Putting on weight

Self care

Treatments for menopausal symptoms after breast cancer

Summary

Treatments for menopausal symptoms

Hormonal treatments for menopausal symptoms

Non-hormonal treatments for menopausal symptoms

Complementary and ‘herbal’ treatments

Other complementary or ‘over-the-counter’ remedies

Bio-identical hormones

Effects of early menopause on long-term health.............. 35 Summary

Long-term effects of menopause

Heart disease

Osteoporosis

Where to find more information

Glossary

Menopause symptom diary

2 – Breast cancer and early menopause — a guide for younger women Acknowledgements

This booklet was developed by:

Professor Martha Hickey Professor Christobel Saunders Professor Kate White Ms Jane Gregson Dr Belinda Thewes Associate Professor Bettina Meiser Professor Michael Friedlander Ms Michelle Peate Dr Andrew Dean Mrs Maria Waters We are most grateful to the many consumers and health professionals who took the time to review and comment on drafts of this booklet.

National Breast and Ovarian Cancer Centre* staff:

Ms Ornella Care Ms Caroline Nehill Dr Helen Zorbas Thank you to Dr Alison Evans, medical writer, for editing the final draft.

This booklet was developed with funding granted by a National Breast Cancer Foundation Concept Award. Printing of the booklet was funded by National Breast and Ovarian Cancer Centre.

* On 30 June 2011, National Breast and Ovarian Cancer Centre (NBOCC) amalgamated with Cancer Australia to form a single national agency, Cancer Australia, to provide leadership in cancer control and improve outcomes for Australians affected by cancer.

–  –  –

This booklet provides information about early menopause and its symptoms.





It describes some of the physical and emotional changes experienced by younger women with breast cancer and offers some practical suggestions for managing these changes.

This booklet is not a replacement for advice given by a health professional and it does not cover all options available. Only a health professional can help individualise your care.

How to use this booklet This booklet is divided into sections to help you find the information most relevant for you. At the beginning of each section there is a summary of key points. There is also a glossary of terms at the end of the book.

–  –  –

There is space at the end of each section for you to make notes or write down questions for your health care team.

4 – Breast cancer and early menopause — a guide for younger women Introduction Summary Menopause refers to a woman’s final menstrual period.

Early menopause can be distressing for younger women.

Most symptoms of early menopause can be managed with appropriate care.

What is menopause?

‘Menopause’ refers to a woman’s final menstrual period. It occurs when a woman’s ovaries no longer produce eggs, which result in her periods stopping. It usually occurs between the ages of 45 and 55.

Stages of menopause

In this booklet we talk about different stages of menopause:

pre-menopause: the time before menopause when a woman has regular monthly menstrual cycles (‘periods’) peri-menopause: the time when menopausal symptoms start (such as hot flushes and irregular periods), leading up to the time of menopause menopause: the final menstrual period post-menopause: the 12 months following the final menstrual period.

Hormone production and menopause Before menopause (pre-menopause), the ovaries release an egg each month. If you do not become pregnant, the lining of the womb breaks down leading to monthly menstruation (‘periods’). During pre-menopause, the ovaries produce three main hormones: oestrogen, progesterone and testosterone.

Breast cancer and early menopause — a guide for younger women – 5 During peri-menopause, menstrual periods become irregular and menopausal symptoms such as hot flushes may occur. The duration of perimenopause varies in individual women. Hormone levels rise and fall during peri-menopause. This can affect many parts of the body, including the uterus (womb), vagina, breast, bone, bladder, brain, and skin. Changes in hormone levels may affect both physical and emotional wellbeing.

Eventually, menstrual periods stop completely (menopause). At menopause, the type and level of hormones produced by the body changes. After menopause, the body produces less oestrogen and usually progesterone production stops. Testosterone levels fall slowly from the mid 20’s onwards but can drop suddenly in women who have their ovaries removed before they have reached menopause.

The hormone changes that occur during peri-menopause and at menopause

affect the body in different ways:

loss of oestrogen is the main cause of menopausal symptoms loss of progesterone is unlikely to cause symptoms

–  –  –

Menopause can cause a number of different symptoms and can increase the risk of other health conditions such as osteoporosis.

Treatments for breast cancer can affect the age of menopause and can influence the available options for managing menopausal symptoms. Early or premature menopause caused by breast cancer treatment can be managed successfully. Some women find that menopausal symptoms have little or no impact. For others, menopausal symptoms can be more severe and can affect their quality of life. This booklet provides information and strategies about how to manage the symptoms of early menopause.

For more information about symptoms of menopause and how to manage them, see the ‘Menopause and breast cancer’ section.

6 – Breast cancer and early menopause — a guide for younger women Younger women and menopause Menopause can be a challenge at any age. When it occurs earlier than expected, it can be particularly distressing. Younger women may face particular difficulties because of their stage of life. While some women feel sad at this time, others feel that they get a new lease of life. They may enjoy having no periods and may feel more confident as a result.

This booklet provides information about early and premature menopause and its symptoms. It also discusses the emotional impact of menopause in younger women and offers some practical suggestions for managing these stresses.

Early menopause: menopause in women younger than 45 Premature menopause: menopause in women younger than 40

You may like to write your questions here:

–  –  –

Treatments for breast cancer can cause menopause in younger women.

Not all breast cancer treatments cause menopause. Ask your specialist about whether your treatment could cause you to become menopausal.

–  –  –

Most symptoms of menopause are temporary and will ease with time.

Some treatments for breast cancer can affect fertility (your ability to have children).

Breast cancer treatment and menopause Each year in Australia, around 13,000 women are diagnosed with breast cancer. About 1500 are younger than 50 at diagnosis. For many women, breast cancer can be treated successfully. However, treatments for breast cancer, such as chemotherapy, radiotherapy and hormonal therapies, can have short and long-term side effects. One side effect in younger women may be menopause.

About two-thirds of women who are younger than 50 when their breast cancer is diagnosed will go through menopause because of their treatment.

If you are peri-menopausal when treatment begins, you may move into menopause more quickly than if you were not receiving treatment. Other women may experience temporary menopausal symptoms. This will depend on the type of treatment and the woman’s age.

8 – Breast cancer and early menopause — a guide for younger women Why do breast cancer treatments cause menopause?

Treatments for breast cancer can affect the ovaries in a number of ways.

These effects can be temporary or permanent.

Temporary or permanent menopause can occur in women receiving chemotherapy or hormonal therapies (drugs like tamoxifen or goserelin [Zoladex®]). Temporary menopause is more common among women who are younger than 35 at the time of treatment. If menopause is temporary, menstrual periods may return within 1 year of stopping treatment. Permanent menopause is more common among women who are 40 or older at the time of treatment. There is no reliable test to predict whether menopause will be temporary or permanent. Although normal menstrual periods may return once treatment finishes, menopause may be permanent, regardless of age.

Permanent menopause occurs in women who have surgery or radiotherapy to the ovaries.



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