Managing menopause and cancer

Care for women in menopause in an oncology setting was discussed in detail at the Gathering Around Cancer Conference.

During her presentation, Dr Helen Ryan outlined that the average age of women engaged with the gynae-oncology service at the Mater Hospital in Dublin is between 45 and 51 years.

“Early menopause is defined as under the age of 45, and a lot of the women we are seeing now have premature ovarian insufficiency, which is defined as under the age of 40,” said Dr Ryan. “The significance of that is multifactorial – these women are often dealing with a new cancer diagnosis, as well as the resulting fertility loss. There are significant quality-of-life effects, both in the short-term and longer-term, but we also know there are profound long-term health implications. This is particularly in terms of longer-term cardiovascular disease risk, which is increased by about 30 per cent for women with menopause under the age of 40, and significant risks of osteoporosis later in life.”

The improving cancer survival rates are encouraging, and there is a growing focus on survivorship and living life after cancer, she said. Menopause symptoms are known to be worse for women who are rapidly induced into a menopausal state and while 75 per cent of women in general will have some symptoms, around one-in-four will report these symptoms as being severe. 

Dr Ryan gave an overview of menopausal symptoms, both physical and psychological, and a synopsis of medical procedures that can trigger menopause, such as oophorectomy and radiation therapy. She said increasing research in this area has resulted in a number of papers published on cancer and menopause in recent years, including guidelines.

In her clinic, Dr Ryan and colleagues are running a prospective trial looking at quality-of-life effects of a dedicated service for these patients.

In consultations, there is a strong focus on lifestyle and trying to improve immediate and longer-term health.

Much consideration is given to non-hormonal treatment options. Communication with the patient is key, said Dr Ryan. “For medications, we are really trying to tailor those around the patient’s most troublesome symptoms,” she said.

“We try to provide individualised and patient-centered care. We focus strongly on [the] shared decision-making aspect to improve quality-of-life benefits for these women and trying to empower them from a lifestyle point of view and give them choices in terms of treatment options.

“We know there is a lot more research needed in this area, but we do have a website developed with colleagues in our oncology department (www.thisisgo.ie). It was developed specifically for gynaecological cancers, but we have a lot of information there about menopause and general health. It’s a really useful resource for both care providers and patients.”