My last menstrual period started one day after my first chemo. I wish I could have known that it was going to be the last one in my life. I was dealing with so much due to my recent breast cancer diagnosis that I didn’t pay much attention. My doctors never gave me detailed information to what was going to happen to my ovaries and estrogen production because of all the drugs I was about to receive; drugs that were going to help cure my cancer. I did not know that I was about to become menopausal at 36 years of age. I was not prepared AT ALL. Passing from being premenopausal to menopausal for cancer patients and survivors might happen, in most cases, overnight.
Many young female cancer survivors, on top of living their diagnosis and treatments, are dealing with this major shake up in their lives, that converts to something physically and emotionally overwhelming. Chemotherapy, radiation, ovarian shutdown with hormone therapy or ovarian removal via surgery can lead to early menopause, temporary or permanent, and it is a fact that a sudden menopause can cause more severe symptoms than a natural one, specially for younger premenopausal women.
Since I had a hormone-sensitive cancer, which means that hormones are like fuel that make tumors grow and spread, my oncologist proposed a “shutdown” of my ovaries and 6 months later, a surgical removal which determines that menopause was irreversible. I was not afraid of being menopausal since I understood that it was another side effect, not very nice indeed, but necessary for my cure and healing. So, I did my best to embrace it with a positive attitude. However, I wish I could have had more resources, counselors and information to help me understand this important “change of life”.
We all know that menopause will come for every single women in the world, usually between their 40s and late 50s when periods become irregular and eventually stop. However, starting to deal with it in your 20s, 30s or early 40s and not because of natural causes, can directly affect your hopes of having babies, bone health, intimacy, mood swings, fatigue, and causing you the not so pleasant hot flashes, night sweats, vaginal dryness, joint pains, weight gain, among other things. Sometimes the downside of menopause can be the main factor for a dip in the quality of life of a survivor, other than the cancer itself or effects of treatments. All these changes can be “normal” for women at an older stage, but they can be very distressing and negatively impact the lives of younger ones if not addressed.
In the Cancer and Menopause study, researchers found that “young women are more likely to experience compromised psycho-social quality of life following the onset of early menopause”. The risk for mental health is a huge concern among doctors and young cancer survivors, to such an extent that we have been called a “vulnerable population”.
Our medical teams, doctors, nurses, counselors, wellness coaches, need to guide us to safe therapies for young survivors in order to overcome the side effects of early menopause, specially when a Hormonal Replacement Therapy (HRT) cannot be prescribed for hormone-sensitive cancer survivors because they can cause cancer to develop, recur and grow. This can be a big challenge that is leading us to explore non-hormonal options to overcome the physical and psychological challenges of this stage.
Here are some ideas to live an early menopause with a more resilient attitude:
- Make this stage memorable. Just the act of acknowledging that this is “a big change in your life” and also that good things may come with it is a HUGE step. Besides, while dealing with survivorship, many cancer patients agree that these ordeals are, most of the time, necessary trials in order to continue enjoying the beauty of life. I remember the day I officially became menopausal, my husband and I decided to have a special dinner at our favorite restaurant and share that moment together. We made that day a memorable day.
- Defend your sleep. Be respectful with your schedules for going to bed and be aware that hot flashes and night sweats can bother the quality of your sleep, and as a result, increase your fatigue. Try to sleep with light gowns or pajamas and leave one or two changes by the side of your bed so you don’t lose precious time in changing wet pajamas for dry ones. One small hint: the bed can be wet too, so you can spread a towel just like at the beach, and sleep on top of it. It is so much easier to remove the towel when it is completely wet because of your sweat, change pajamas, and continue sleeping, than looking for another dry place to rest! Cold packs will help. Avoid or decrease caffeine consumption.
- Eat healthy and nutritious meals and supplements. Weight gain and bone health are two possible side effects of menopause and healthy eating can help with both. Besides that, nutritious meals will boost your immune system in order to prevent cancer recurrence and other diseases. Increase the intake of fruits and vegetables, avoid junk food, eat whole grains, good sources of protein, healthy fats. Cancer fighting diets like the one proposed by Dr. David Servan-Schreiber are ever more advising to eat plant-based diets, limit red meat, choose whole grains, avoid processed meats, avoid alcohol, drink water every day (hydration helps with hot flashes as well), among other tips. Ask your doctor about supplements like calcium and vitamin D that also can help to strengthen your bones and immune system.
- Stay active. Exercise will help you with reduction of joint pain and body aches, overcome mood swings, depression and anxiety, fight weight gain. Choose some physical activities that you can easily be engaged with and enjoy. You could do it alone or with a group. Yoga, running, swimming, hiking, biking, spinning, zumba, etc. There are tons of exercises and physical activities that we can start practicing today that even if we don’t want to start doing them, once we decide to do it, we will feel the positive consequences of this important habit. Exercise also helps with good sleep and better tolerance for hot flashes.
- Improve intimacy and address fertility. Since vaginal dryness is an important side effect of menopause, intimacy challenges can be complex and physically and emotionally painful. Don’t let them go untreated. Look for the professional advice of your doctor or a couple counselor if necessary. Communication with your spouse or partner is key. Also, if you have fertility concerns, talk about it together and share your fears and desires. It is not easy to accept that biological children are not going to be a reality in the future. However, there is so much beauty in the acceptance and exploration of options like adoption to grow and build a family.
- Holistic alternatives. The practice of mindfulness, conscious breathing, positive thinking, acupuncture, healing massages, can also improve the spiritual well-being which has been proven to bring more joy and better health outcomes.
Let’s face it: menopause will come sooner or later bringing unexpected challenges, as many other life experiences have. As younger cancer survivors we can embrace it and responsibly look for appropriate practices to overcome the most common side effects for not only protecting but also enhancing our physical and emotional well-being. Thanks to lifestyle changes, non-hormonal interventions and mind-soul-body connection a better life after early menopause is possible and real.
In her book “Menopause without medicine”, Linda Ojeda, PhD, shared that according to researchers, Mayan women in Mexico are not suffering from some of the serious side effects of menopause even when they are not “endocrinologically” different from other women in the world. Why? Well, conclusions said that it is their attitude that is different: they are WELCOMING the transition!
Since the only certain thing of early menopause is that it too shall pass, let’s try to enjoy the ride of a transformation that can lead us to a better version of ourselves.
“How smoothly a woman adapts to any transition depends largely on her overall health- that of her body, her mind, and her spirit.” (Linda Ojea, PhD)