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Life after cancer | Surgical menopause

 What is "surgical menopause"?

 How will it feel going through surgical menopause?

 Should I take Hormone Replacement Therapy (HRT) to ease surgical menopause?

 Is it OK to have Hormone Replacement Therapy (HRT) after treatment for uterine cancer?

 Are there other ways, besides HRT, to deal with the effects of surgical menopause?

 

 What is "surgical menopause"?

 Karen, Alberta, Canada: This term refers to a premature menopause - most commonly from surgery (oophorectomy, removal of the ovaries, quite often done at the same time as a hysterectomy), but it can also be an after-effect of pelvic radiation treatments.

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 How will it feel going through a surgical menopause?

 Cathy B., Ontario, Canada: We have all heard of the 'hot flashes' and irritability associated with natural menopause. Each women is unique in the way her body reacts to this time of life. It's the same with a 'fast-forwarding' of menopause due to surgery or radiation, in my experience. I had night sweats and burning in my cheeks for several months, but, for me, it wasn't unbearable. I found, however, my moods would change easily and my already short temper was even shorter. This subsided though and now it seems to have balanced itself out. I do think it has affected my memory - sometimes I struggle to remember names, numbers .... things like that. Also, my skin tends to be a bit dryer than it was prior to menopause.

 Karen, Alberta, Canada: When my ovaries stopped functioning at age thirty-four from radiation treatments, the main menopausal symptoms I had were hot flashes, vaginal dryness, moodiness, and "foggy brain". Besides the hot flashes, which ceased once I started on estrogen, my whole temperature regulation system seemed to be out of whack - for about three years, I was always very warm and the smallest exertion made me overheat. The "foggy brain" symptoms (besides being forgetful and searching for words, names etc, I also had a hard time concentrating) have also mostly subsided.

 Mae, New York, USA: I was 39 when I had endometrial cancer. I became menopausal as a result of my surgery (total hysterectomy, with both ovaries removed) and it was immediate. While I was still in the hospital, I was cold, then I was hot. I did not know why this was happening until a nurse told me that it was a result of the surgery. At 39 years old, my body was in for a shock - and so was I. I had night sweats, and I was having hot flashes all the time. It took a long time for me to adjust to this - at least a year or more! I was very angry, frustrated and embarrassed to be sweating all the time. My family and friends knew what was happening. However, at work, only five people knew the whole story. A close friend bought me a personal fan to carry with me. The hot flashes have finally gotten better and I learned to be calm when they were occurring which also helped me.

 Susan L., Michigan, USA: I was diagnosed with endometrial stromal sarcoma when I was 48. Getting a cancer diagnosis was very frightening. Dealing with the diagnosis was difficult, and then having to deal with surgical menopause made it mind-boggling. Surgical menopause can be compared to drug withdrawal and is much more severe than a usual normal menopause because it is so sudden. Then to top it off, the oncologist told me that my uterine cancer was hormonally receptive, and I would need to take an anti-estrogen medication.

Within days of my surgery, I was having hot flashes and mood swings. It felt like bad premenstrual syndrome, only with no menstrual period for relief. Everyday was just another tense and moody day - and I was already feeling this way anyway, after the major shock of diagnosis and surgery! My doctor prescribed various antidepressants which were successful in regulating my moods, but I was still having up to twenty severe hot flashes daily.

I read a research article about another antidepressant, Effexor, being successful in helping women with hot flashes. The study said this was especially of interest in women taking tamoxifen or other anti-estrogens because of the hot flash side-effects. So I began taking it. This made a tremendous difference with both my mood stability and the hot flashes. I felt normal again ... well, normal mentally. ;-) I still have hot flashes, but they are much less frequent and much less severe.

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 Should I take hormone replacement therapy (HRT) to ease surgical menopause?

 Karen, Alberta, Canada: This is a decision that you and your doctor will have to make, taking into consideration the type of cancer you had (some kinds of cancer thrive on estrogen, so replacement is a no-no), the severity of your menopausal symptoms, your age, your familial risk factors for osteoporosis and heart disease etc.

I have now been on HRT for five years. In my case, undergoing menopause at age thirty-four with a strong family history of both osteoporosis and heart disease, but none of breast cancer, my doctor and I decided that I should probably stay on estrogen until my early fifties, and then, at the age when most women would be initially considering HRT, reconsider based on the situation then. One concern is that the long-term effects of estrogen replacement are not really all that well known - studies done so far have been contradictory, some showing that the risk of breast cancers rise after more than five years on HRT, others showing that it does not. There is a huge long-term study underway now in the US, to be finalized sometime in the next couple of years. I am sure I will be discussing those findings with my physician then.

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 Is it OK to have hormone replacement therapy (HRT) after treatment for uterine cancer?

 Sue D., Pennsylvania, USA: Taking HRT with a history of endometrial cancer has been controversial ever since the 1960s when doctors discovered that taking estrogen supplements alone (unopposed estrogen) after menopause increased women's risk of developing endometrial cancer. Since then, HRT has always been offered with another hormone, progesterone, to eliminate that risk. Here article from Oncology.com provides an overview of the risks and benefits of HRT for endometrial and breast cancer surviors. http://www.oncology.com/news/news_view/1,1017,2500_2501_1,00.html

But what if you don't have a uterus anymore? Is estrogen safe, then? That is the question many of endometrial cancer survivors have asked! The latest studies have suggested that HRT for early stage (stage 1) endometrial cancer is probably quite safe, so the answer is not the flat-out "no" that it used to be. See the press release announcing the results of this recent study of HRT after early stage endometrial cancer. http://www.canceroption.com/media/2000/02/06/pr/0000-2385-ca-estrogen-sgo-study.htm

The HRT decision is one you will have to make with your doctor weighing your age, cancer stage, personal and family history of cancer, heart disease, and osteoporosis.

I was forty-four years old and pre-menopausal when my Stage IA endometrial cancer was discovered and treated with a total hysterectomy with removal of the ovaries and fallopian tubes. The hot flashes from instant menopause weren't as much a concern for me as being suddenly thrust into a higher risk group for cardiac disease. My father and his father had died in their forties and early fifties of heart disease, yet there was no cancer in the family outside of me. I made a health family tree and talked to my gyn/oncologist about it at my six week post-surgery check-up. He agreed that I was more at risk for heart disease than a cancer recurrence at Stage 1, so he prescribed a low dose of Premarin. It's a risk I feel better about taking than risking early heart disease.

 Georgia P., Massachusetts, USA: I was postmenopausal when I was diagnosed with Stage 3 endometrial cancer. After my treatment with surgery and radiation, my gynecologist never even mentioned the possibility of HRT--at that stage, even with some family history of heart disease, it was out of the question. Besides, I had already negotiated menopause without HRT.

 Mae, New York, USA: I was 39 when I was diagnosed with endometrial cancer, stage 1, grade 3. I became menopausal as a result of my surgery (total hysterectomy, with both ovaries removed) and it was immediate.

I had night sweats and I was having hot flashes all the time. It took a long time for me to adjust to this - at least a year or more! I was very angry, frustrated and embarrassed to be sweating all the time. The hot flashes have finally gotten better and I learned to be calm when they were occurring, which also helped me.

In addition to my own cancer history, my mother had estrogen- receptive breast cancer, and her doctor did not recommend that I stay on HRT for an extended length of time. Premarin, an oral estrogen, was recommended by my surgeon but after reading the lengthy contraindications, I never used it. My gynecologist prescribed a hormonal vaginal cream (estriol) to ease vaginal dryness. I was nervous about using hormone pills which would go into my bloodstream, but I was more comfortable with the idea of using a vaginal estrogen cream. It is the made by a company that specializes in "bio- identical" hormones. This means that the hormones have the same chemical structure as hormones that are made by our bodies, and according to medical literature I have read, are better tolerated and have fewer side effects. However, I only use the cream sporadically as I am still nervous about using any hormones.

 Susan L., Michigan, USA: I was diagnosed with stage 1 endometrial stromal sarcoma when I was 48, and went through menopause after surgery. Some uterine cancers are estrogen-fed just as many breast cancers are. My uterine cancer was positive for estrogen receptors - so not only should I not take HRT, but I am taking an anti-estrogenic drug and must watch my diet to try to avoid natural estrogens, so no black cohosh, soy or yam for me.

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 Are there other ways, besides HRT, to deal with the effects of surgical menopause?

 Susan L., Michigan, USA: I basically worked through all my problems one symptom at a time. I did a lot of research, and had help from some great nurses, including a nurse at a women's clinic who helped me quite a bit, as did my own wonderful nurse practitioner, who has been willing to help me experiment until we found the perfect balance for me. What I suggest is: Make a list of the symptoms that bother you; start with the worst one and work through your list one thing at a time. When estrogen is not an option, you need to help yourself and not be miserable with symptoms.

In the hospital after my surgery, my gynecologic oncologist told me to take 800 IU a day of vitamin E to help with the hot flashes: 400 IU in the morning, and 400 IU in the evening. This has the added benefit of keeping your hair and skin nice. He also said many women had good results with a certain high blood pressure medication. However, after reading more about it, I felt that I couldn't cope with the side effects it might cause.

I started with the vitamin E, but within days of my surgery, I was having hot flashes and mood swings. I called the doctor and he prescribed an antidepressant. After trying different antidepressants with success on the moods, I was still having up to twenty severe hot flashes daily. I read a research article about a study on another antidepressant, Effexor, being successful in helping women with hot flashes. The study said this was especially of interest in women taking tamoxifen or other anti-estrogens because of the hot flash side effects and no HRT. So I began taking it, and it made a tremendous difference with mood stability and hot flashes. I felt normal again ... Well, normal mentally. ;-) I still have hot flashes, but they are much less frequent and much less severe. Effexor isn't perfect, but it's the best thing researchers have found and helps with about 65% of the severity and frequency. The antidepressant Paxil has also been studied for hot flashes, so women have a choice and may want to talk to their doctor and research the side effects of both drugs.

When you have hot flashes, wearing layers of clothing is helpful, especially cotton. Try a sweater over a sleeveless shirt. A glass of ice water is handy and also helps. I keep a small electric fan on my nightstand and turn that on when I am having an especially warm night. A nice folding paper oriental fan is handy to carry and doesn't look so bad when you pull it out to fan yourself. People ask where I buy them, and I've started to give them to friends as a gift on their fiftieth birthday ... kind of as a gag, but they use them.

Be sure you keep an eye on the health of your bones and get bone density tests. You have to be careful to get enough calcium, supplementing it if you do not get enough in your diet. Do your research on calcium because it has to be the type that your body can absorb. You should also do weight-bearing exercise at least three times a week - walk, and if you can, lift some hand weights. Your arms will look nice and you'll be helping your bones. You don't need to use heavy weights; just do a bunch of repetitions. You can even keep light hand weights by your computer and do a few lifts while reading e-mail.

You should eat at least five servings of fruits and vegetables each day. I even heard that cancer survivors should aim for ten. Whew! Working up to five was not easy for me. But after a while, I began to be hungry for an apple or a salad.

Without estrogen, sometimes I forget things or have to search for a word. Although my memory is not that much worse than it used to be, the notebook/calendar I've always used seems to be more important now. It's always in my purse or on my desk ... now if I can just remember where! :-)

Disruptions to my sleep patterns have been harder to deal with. Exercise seems to help, as does avoiding caffeine after dinner. I try not to snack too late because that seems to affect my sleep. If you are having a lot of problems sleeping, your doctor can help you with a mild sleeping aid.

The lack of estrogen after menopause can make your bladder more active. If you're running to the restroom more often, tell your doctor. This can be dealt with.

Lots of women have problems with sex after surgery, even if they are on estrogen. Talk to your doctor. Sex is difficult to bring up, but it is a part of every human being. Your doctor is trained to talk with you. He/she probably won't bring it up, but if you approach the subject, they will help and will try to help you be comfortable talking about it. Antidepressants can affect your ability to respond. Lack of estrogen may be causing vaginal dryness. Vitamin E should help with the dryness, but if not, look over the shelves at your drugstore - there are a number of products there for this problem.

It took me a year to find a balance of medications that made me feel rather "normal" yet no doubt, there are other things going on in my body that I'm unaware of. For instance, the medication for my hot flashes gave me a dry mouth, which in turn caused some dental problems for the first time in years. However, it's been twenty months for me with no estrogen, and I can say that I pretty much feel like I did with it. There is no one magic way to return to feeling normal, but it can be done.