Managing Menopause and More with Gynecologic Cancer

Experts are now prioritizing improving quality of life for gynecologic cancer survivors

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With gynecologic cancer patients living longer, cancer experts are putting an increasing focus on improving patients’ quality of life. For many, that means managing hot flashes, night sweats, mood swings and other bodily changes most women don’t experience until later in life. That’s because for many women, even those in their 20s and 30s, gynecologic cancer treatments often cause a number of side effects—including symptoms of menopause.

An estimated 89,000 women in the United States are diagnosed with a gynecologic cancer each year. Defined as cancer of the female reproductive system, gynecologic cancer includes five main types: ovarian, cervical, uterine, vaginal and vulvar. The two most common types of gynecologic cancer—ovarian and uterine—occur most often in women who are going through or have completed menopause, but they may occur in women who are younger, too.

In fact, research suggests that 30 to 40 percent of all women with a gynecologic cancer experience menopause earlier than they would have without the disease. “Many times, treatment for gynecologic cancer will make a woman go through menopause before she normally would,” says Dr. John Farley, a gynecologic oncologist at Cancer Treatment Centers of America® (CTCA), Phoenix. “That means she isn’t able to have children and has to deal with the problems associated with menopause, too, such as hot flashes, vaginal dryness, osteoporosis, mood swings, depression, sexual dysfunction and pain during sex.”

Medically induced menopause that results from cancer treatment may develop more quickly and its side effects may be more severe than naturally occurring menopause. Patients who undergo treatments for other types of cancer do not typically experience premature menopause as a result. But for many gynecologic cancer patients, chemotherapy and radiation therapy often damage the ovaries, or they may undergo surgery to remove one or both ovaries. Menopause occurs when the ovaries no longer produce the hormones estrogen and progesterone, which control menstruation and ovulation, so damaging or removing the ovaries often triggers menopause.

Many younger gynecologic cancer patients worry about the impact of early menopause on their ability to have children after treatment. Several oncofertility preservation options may be available, so Dr. Farley recommends that patients discuss their concerns and possible solutions with their doctor before treatment.

For patients experiencing menopausal symptoms, Dr. Farley offers some tips that may help. To manage hot flashes, for example, try cooling fans, lighter bedding and turning down the thermostat before you go to bed. To ease vaginal dryness and sexual dysfunction, ask your doctor about vaginal estrogen creams, lubricants or dilators.

Women with gynecologic cancer often experience other side effects, including fatigue, “chemo brain,” neuropathy, a suppressed immune system, as well as scarring in the vagina or abdominal cavity, which may lead to sexual dysfunction, Dr. Farley says. These side effects are typically addressed as they appear. As soon as neuropathy begins to develop, for example, doctors may lower the dose of the chemotherapy drug. Exercise may help reduce symptoms of neuropathy and fatigue, and changes to your diet may help relieve stress and fatigue. “Exercise and eating a healthy diet are always good to try and can help with several issues,” Dr. Farley says.