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Medically Induced Menopause
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Medically Induced Menopause

I have been reading up a bit about medically induced menopause. As it is induced by chemotherapy for cancer, I was wondering if the same occurs with our HCV treatment. If this really occurs with TX, I feel the need to look into this matter further and discuss some kind of damage control with a physician, concerning hormone therapies, osteoporosis and other factors.

Any input appreciated.  Marcia


CHEMOTHERAPY-INDUCED MENOPAUSE:  A Clinical Research Study

Chemotherapy-induced menopause was the subject of a clinical research study at the Cancer Center at GBMC and the results were published in Cancer Investigation, 19(6), 641-648 (2001). The study was led by Barbara Poniatowski, MS, RN, C, AORN, clinical nurse specialist and Gary Cohen, MD, Medical Director, Cancer Center, with additional help from Patricia Grimm, MD. A summary of that article follows.

Women who experience menopause before the age of 40 are classified as having premature menopause, which can be induced through ovarian ablation either by surgery, radiation or certain chemotherapeutic agents. A recent published study of 113 premenopausal women treated with adjuvant chemotherapy showed that 38% developed amenorrhea (abnormal absence or suppression of menstruation) during the first year, 36% had irregular menstrual periods and 22% continued regular menses.

If the premature menopause is permanent, the woman will spend as much as one-half of her life in the postmenopausal state (in contrast to one-third of her life with natural menopause). Symptoms produced by premature menopause may be of short or long duration, and can produce physical and psychological distress that impact quality of life.

Premature menopause caused by adjuvant chemotherapy has received scant attention because, historically, breast cancer was a surgical event. Prematurely induced menopause is now of interest because adjuvant chemotherapy with alkylating agents is an accepted and expected part of breast cancer treatment. Most women who are less than 50 years of age will receive adjuvant chemotherapy, which is estimated to reduce recurrence by 30-40% and death by 25%. These women will begin to experience menopausal symptoms 6-12 weeks after therapy. Amenorrhea may be permanent in women who are near the age of natural menopause,with those under age 35 almost always recovering ovarian function.

The chemotherapy-induced premature menopause in younger women may be short-term but could last for months or years. Menopause may place women at an increased risk for both osteoporotic fractures and cardiovascular disease. Because of rapidly declining estrogen levels, the hot flashes, night sweats, vaginal dryness and atrophy caused by chemotherapy-induced menopause may be more severe than the symptoms with natural menopause. As with natural menopause, the vaginal symptoms can lead to difficult or painful intercourse and sexual dysfunction.

The psychological symptoms associated with premature menopause appear to be the same as the symptoms associated with natural menopause. However, women experiencing premature menopause are more concerned about the long-term sequelae than women experiencing natural menopause, due in part to the extended duration of their life in the menopausal state.

Although effective treatments exist to counteract menopausal symptoms, breast cancer patients often fear and avoid estrogen and resort to homeopathic remedies with equivocal results rather than accept estrogen or progesterone creams, estring, megestrol acetate, and other hormone-replacement strategies with proven effectiveness. Randomized controlled trials have also demonstrated symptom relief with the use of certain antidepressants (e.g. paroxetine, venlafaxine, fluoxetine, etc) but some patients refuse those agents because of their association with psychiatric disease. Women suffer in silence and live with unpleasant symptoms for years. Further research is clearly needed to identify risk factors for and safe methods to treat symptoms of premature menopause.
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18 Comments Post a Comment
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476246_tn?1310999221
Thank you for your input.

I hope your son is feeling better these days. I have followed you a little from afar and must say that I admire your strength and courage. You are both in my prayers.

Marcia
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Sorry, can't help much.  I already had the chemotherapy induced premature menopause when I began this tx.  My hep doctor had warned me that tx could put me into menopause if I was not already there.

jd
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476246_tn?1310999221
Thank you, maybe you can help me anyway. I am very interested in what you are doing regarding precautions to osteoporosis. Are you being checked for bone density or have they done anything to monitor you. That is actually what i am really interested in, not just if the premature menopause happens or not. Did they put you on estrogen or progesterone etc.

Any info welcome

Marcia
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I also had very high doses of radiation in the pelvic area, so this may have contributed to my situation.  I am checked for bone density (so far, so good), but not taking any meds.  I prefer to keep medical intervention to the bare minimum.  I have not had a difficult menopause, or if I did it was masked by the side effects of the chemo and radiation.

jd
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476246_tn?1310999221
Thank you so much for the info.

There are many natural ways of improving bone density. I think I will start looking into it. Different kind of exercise etc. I think that even Pilates is a good one for that.

Marcia
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Exercise is my preferred method.  Almost any weight-bearing exercise aids in improving bone density.  Also, maintaining good muscle tone and joint health.  I walk and swim for cardio and do some Pilates mat work.  
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I will be two years post tx in november, I was always regular like clock work until 2 months into my 48 week stint, that was it  never another period until 1 month post and then it came back hard, and now i have one every month but  cant count on the day or week anymore i will be 44 in july.....

                               Blessings
                                         Goldyn
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I don't know because I'm on Estrogen only replacement therapy anyway.  I had a complete hysterectomy at age 30, so.    I'm not interested in stopping my Estrogen and yes, I know the risks and I really don't care all that much.  I have mild osteopenia already started in my back and the Estrogen and slow that down.  I have no history of breast cancer in my family and I get regular mammo's, so I'm not even slighlty worried about it.  Also, having enough Estrogen actually is a good thing because otherwise, I'd have the same risk factors for progression as a man does, since w/no ovaries, I'd have zero Estrogen.    It's a plant-based gel that gets rubbed onto the arm (by prescription only) and it's actually safer for the liver than pills.  I am not on any Progesterone since I have no uterus and I'm not on any Testosterone.

Susan
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476246_tn?1310999221
Thank you so much for sharing, I really appreciate it very much. Jd and Susan, you have gone through some tough times, I'm really sorry to hear that.

I have had totally crazy periods for about 4 years now. It all started after my mother passed away from leukemia. I nursed her for 1 1/2 years, and was very tired.
I was even coming down with hot flushes and dryness at the time. I bought a topical progesterone cream at the health store and used it for a few months and the flushes went away and I got back to normal. I stopped it and some time later, the menses started messing up again. But I don't have the other problems anymore, just the irregularity.

Sometimes I have amenorrhea for up to 4 months and then very heavy menses after that. Sometimes they come every 2 or 3 weeks, mild and strong. There is no real pattern. Also the last two years I have been traveling a lot and long plane rides can do the same. But I have noticed that not traveling for the past few months has not brought any regularity to that either. I thought I had come into perimenopause (a bit too early at my age), but several blood tests have confirmed that I'm not. So my doctor ruled it out. Well, since we also know that hepatits c can cause irregular menses,  I'll have to leave it at that. Blame it on the hep c.

Marcia






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475300_tn?1312426726
I also had a complete hysterectomy at age 40 (I'm 46).  My gynie also had me on the estrogel like Susan400.  I haven't used it for a year since I got diagnosed with Porphyria PCT due to the hep.  Estrogen can bring on the PCT and I am afraid to use it again.  I will find out in Sept when I go back to the gynie.  I take calcium citrate not calcium carbonate like in tums.  Carbonate is not supposed to be as good as citrate.  I think I am going to ask for a bone density test at this visit just to be sure.  One hears so much about estrogens that is not good just like everything else out there LOL.

Denise

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476246_tn?1310999221
Denise, thanks for the info.

Wow, some of you have really been through the mill. I really have respect for you.

God bless,

Marcia
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250084_tn?1303311035
Weeeeellll......I'm still trying to figure it out :)
First several weeksof tx I had a period every week-10 days (not good for the ol' Hgb!)
Than very few thru out the rest (24 week tx) , than after started back to normal, now 4 mths. post I've had none in 6 weeks (not pregnant:)  So I'm wondering myself. I'm 50 tho, had no signs of menopause before tx and 1/2 way thru tx my hormone check said I wasn't there, I was at 'fertility level' ! That was last Dec.

All I know for sure...if/when sex I'm using THREE forms of birth control, LOL

LL
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250084_tn?1303311035
Hey guys.......isn't this where you guys chime in on the 'all womens thread'  :) ??
Tread in and tread out lightly, lol!

LL

(I know I got Willy right, not sure if it was jmjm on one of them?)
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475300_tn?1312426726
It actually took 3 surgeries  get the complete hyst.  First one they told me I had ovarian cancer (I didn't) and took out the left tube & ovary.  About 9 months later I'm back in the ER doubled over and ready to pass out, they took out my appendix & pumped me full of antibiotics, while I was in the hospital I got double pneumonia.  2 months later back in the ER for the complete hyst. So I went thru heII but it is over, thank God.  That is over and I really hope the hep is over too.  The thing that I can't really understand is why nothing odd showed up on any blood work to cause them to suggest the test for hep.

Denise
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476246_tn?1310999221
Thank you. That actually sounds very encouraging, not the 10 days every week, but that you actually had it, even though it has become a bit messed up. I wonder if it also has to do with txing for 24w vs 48w. Theoretically there should be less harm done with a shorter treatment.

As to contraception, I am fortunate to have had a tubal ligation the day after giving birth to my 5th child in 1991. So one thing less to worry about.

Theoretically, the birth control should keep you regular. Hmm... just wondering what is happening there, with the 6 weeks.


Marcia


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476246_tn?1310999221
What a terrible nightmare. And then tx after all that... I really pray for a beautiful SVR.

Marcia


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250084_tn?1303311035
GSD.........dam! Has lawsuit come to mind :) ? Glad it's past.

Marcia.....Theoretically, the birth control should keep you regular..........
don't do the 'pill' or anything like it, never have. Always felt they were damaging. THO.... I WISH I had a tubal ligation! I have had 1 tubal pregnancy, 4 miscarraiges and 3 births. My last miscarrairge I was hemmoraging and said 'PLEASE tie my tubes"  as they are rushing me into surgery...(43, 5 kids with step kids at home!) and they said "oh, we can't , you have to sign a release 30 days before one! At the same time telling me 'don't ever get pregnant again'! I am petrified of drugs, surgery so never got it and the few times I was ready, no insurance, etc. And every preganancy was with some form of birth control! My family jokes that I have a cast iron uterus and should have sold my egg's long ago :) I now have a signed release form in case! (I swear!)

My dating requirements include full blood work AND a vasectomy :)

( to u know who.....killing ya' here aren't I :), LMAO :)
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476246_tn?1310999221
Ha, ha..... I know the teasing just too well. They used to say to me that one just needs to dangle a pair of husbands briefs in front of me and I would get pregnant. I had 5 in 7 years and then my gynie said that she thought I should stop now... I was 28 with 5 kids.... As I really did not want to have more children, I took up her advice and we planned it during my last pregnancy. In Indonesia they had some kind of law that they were not allowed to perform a tubal ligation on women under 30, but as I had so many children, they were able to make an exception. Now I married a man with five children, so I ended up having ten anyway :-) Isn't life beautiful!

Marcia
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