Menopausal Symptoms

Menopause is a natural process of a woman’s life, when the ovaries stop producing hormones, regular periods stop and the ability to bear children ends. Most women become menopausal naturally between the ages of 45 and 55 years. Some cancer treatments can also cause menopause to occur much earlier than usual. This may result in menopausal symptoms that may cause discomfort and affect your daily life.

Causes of Menopause in Cancer

The following cancer treatments can cause early menopause and/or side effects that are similar to menopausal symptoms:

Chemotherapy drugs
Hormonal therapy e.g. Tamoxifen, Anastrozole, Letrozole, Exemestane, Leuprorelin, Goserelin
Radiotherapy to the hip or pelvic areas
Surgery to remove the ovaries, which causes permanent menopause

What you need to look out for

Mainly caused by hormonal changes within the body, common menopausal symptoms are listed below. Some women may have one or more of these symptoms, and the severity may vary:

Hot flashes. These may manifest as sudden warmth in your face, neck or chest. Some women may perspire or feel their heart beating faster. Although these usually go away within a few minutes, flashes and sweats occurring at night may disrupt sleep.

Mood changes. Also called mood swings, these are changes in your emotional state, where you may experience fluctuating emotions like feeling happy one moment and upset the next, sometimes for no reason. The most common emotions experienced are sadness, frustration, irritation and anxiety.

Vaginal and urinary changes. Low hormone levels can cause tissue thinning, dryness and irritation in the vaginal area, in turn causing discomfort and pain, especially during sexual intercourse or gynaecological examinations. Some women may also experience more infections in the area (e.g. urinary tract infections).

Skin changes. Lower hormone levels can cause your skin to become thinner and drier. You might also develop acne, due to changes in your hormone levels.

Difficulty sleeping. It is unclear how the changes in hormone levels can directly affect your sleep, but other menopausal symptoms such as hot flashes, night sweats and mood changes can all interrupt sleep, and the lack of sleep can in turn lead to other problems such as feeling irritable, tired and having poorer memory and concentration.

Loss of interest in sex. You may also experience a lower sex drive, and this may be caused by not only changes in hormone levels, but also other menopausal symptoms like hot flashes and vaginal dryness, or cancer and its treatments.

Menopause can also have other effects on the body such as thinning of the bones (osteoporosis), infertility and increased risk of heart disease. Talk to your healthcare team to explore ways to manage these issues, so that they do not affect your quality of life.

How it can be treated

Your doctor or nurse may ask you more questions regarding the symptom(s) that you are concerned about, and recommend you practical tips to manage them (see section on “What you can do”). Depending on your needs and concerns, you may also be referred to the sexuality clinic or the psychosocial team, to help you cope better with your menopausal symptoms.

What you can do

The following are some of the lifestyle changes that you may adopt:

Hot flashes

Take note of what triggers your hot flashes (e.g. drinking alcohol or caffeine, eating hot and spicy foods, red meats, smoking) and try to avoid these triggers

Wear loose fitting and thin layers of clothing to keep yourself cool. Use fabric made of natural fibres such as cotton, and avoid synthetic fabrics

Have cold instead of hot drinks

Take cold instead of hot showers. Use a facial water spray to refresh yourself when needed

Keep windows open to ensure good ventilation. Use fans and air conditioning to keep yourself cool

Eat healthy meals and exercise regularly to enhance wellbeing and general health

Avoid taking any traditional Chinese medication or health supplements (e.g. soy-based products, black cohosh, Dong Quai, Ginseng) for hot flashes before discussing with your doctor

Mood changes

Try relaxation techniques (e.g. deep breathing exercises, meditation, yoga) or engage actively in hobbies that you enjoy

Exercise regularly, to boost mood and ease anxiety

Eat healthy snacks and small frequent meals as hunger may trigger mood swings

Talk about your emotions with your close family or friends. Sharing about your feelings helps you ventilate and feel better

Participate in support groups to meet and learn from others who have similar experiences

Have adequate sleep. Inform your doctor if you have persistent sleep problems

Avoid alcoholic beverages. These have depressant effects and can worsen your mood

Vaginal and urinary changes

Use vaginal lubricants to reduce vaginal friction and increase comfort during sexual intercourse

Apply barrier cream over the vulva area especially before swimming, as chlorine in swimming pools is very drying and can cause further irritation

Drink plenty of water daily unless instructed otherwise by your doctor. This is to keep your bladder healthy and reduce the risk of developing urinary tract infections

To prevent urinary tract infection, always wipe from the front to the back after using the bathroom, so that bacteria would not be brought from the anus to the urethra

Avoid cleansing products that may be drying or harsh on the skin (e.g. those that contain alcohol or fragrance)

Avoid activities that can cause additional friction or rubbing over the area (e.g. cycling or stationary bike riding)

Do not be hesitant to see a sexual therapist, psychologist or social worker if recommended by your doctor or nurse. They can provide counselling and therapy to help you with sexuality-related problems

Skin changes

Apply sunscreen, and wear a cap or long-sleeved clothes to protect your skin when going outside

Apply mild, fragrance-free moisturizer daily

Avoid skin products with alcohol or fragrance (including perfumes, colognes, soaps, aftershaves) as they can cause irritation and dryness

Avoid being in direct sunlight

Avoid body products that can be rough on your skin (e.g. bath scrubs)

When to consult your cancer care team

Please inform your doctor or nurse if you feel that any menopausal symptom is affecting your daily life, or if you experience any of the following:

Persistent poor sleep
Feeling sad and losing interest in things
Difficulty coping with family life or work

If you are a patient with NCCS, you may also call +65 6306 1777 or +65 6436 8088 to book an appointment to speak to an NCCS medical social worker.

If you have any questions regarding the above information, please call Cancer Helpline at +65 6225 5655 or approach your doctor or nurse for further details.

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The above contents are made available as part of TEMASEK FOUNDATION-ACCESS (Accessible Cancer Care to Enable Support for Survivors) PROGRAMME, a holistic care programme to support cancer patients during their care and recovery journey.

The contents have been approved by the Cancer Education Information Service, National Cancer Centre Singapore (NCCS), for people with cancer and their families and caregivers. However, this information serves only as a guide and should not be used as a substitute for medical diagnosis, treatment or advice. For specific medical conditions, please seek expert medical advice from your healthcare team.

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Menopausal Symptoms and Cancer