Menopause and gynecologic cancer

#Cancer is a frequent and sometimes fatal health problem and one of the leading causes of disease worldwide. Women with gynaecological cancer experience psychological problems such as frustration, despair, depression, lack of anger control, disruption in body image, and abstention from sexual life. Sexual dysfunction is one of the most common and distressing quality-of-life issues that female cancer survivors face. Yet it is rarely discussed between cancer patients and survivors and their providers.

Early menopause, typically referred to as menopause before the age of 40, has been associated with the treatment of certain gynecologic cancers. Menopausal symptoms triggered by cancer treatment can be more abrupt, intense, and/or prolonged than those of natural menopause. The incidence of early menopause can have devastating effects on young women, both from a sexual health standpoint to psychological effects such as body image disorders to even the feeling of inadequacy from not being able to bear children. Intimate relationships can be profoundly affected, perhaps even more so for those in sexual minorities for whom additional barriers to communication and sexual health discussion have been identified.

Treatment and symptom management of menopausal symptoms include hormone replacement therapy (HRT), nonhormonal medications, and behavioural interventions. Hormonal replacement therapy is associated with the risk of heart disease/heart attack, stroke, and breast cancer. The decision of whether or not to use HRT should be part of a comprehensive health assessment including lifestyle, diet, exercise, smoking, and alcohol. Overall, symptom and survival outcomes vary by primary gynecologic malignancy. Whereas antidepressants, including selective serotonin reuptake inhibitors and anticonvulsants, are the primary classes of nonhormonal drugs used to manage menopausal symptoms in women with cancer.


Behavioural interventions include lowering room temperature, using fans to circulate air, dressing in layers to allow for removal of outer clothing as vasomotor symptoms occur, and moderating dietary contributors such as alcohol, spicy foods, and caffeine. Nutritional supplements, including herbal supplements such as black cohosh, have demonstrated mixed efficacy in reducing hot flashes.

Sexuality is a central aspect of being human throughout life and encompasses sex, gender identities and roles, sexual orientation, eroticism, pleasure, intimacy, and reproduction. At least 50% of individuals treated for reproductive malignancies report sexual dysfunction, with 18.2% of women with cancer reporting dissatisfaction with sexual function as compared with healthy controls. Sexual dysfunction is often categorized in three areas: physical (eg, vaginal dryness), psychological/emotional (eg, decreased sexual interest), and interpersonal (eg, loss of intimacy).

Gynecologic cancer affects women of varying ages, backgrounds, marital status, as well as sexual orientation. The issue of sexuality and sexual dysfunction is often lost in the midst of a gynecologic cancer diagnosis with initial concerns focused on the diagnosis itself, preparation for treatment, and coping with the disease process.

Gynecologic cancer patients should receive counselling before treatment to address fears, myths, and what to expect with regard to their sexual function, which should include a partner at the patient’s discretion. Providers, including nurses, should evaluate their own comfort level, and biases and utilize evidence-based tools to guide conversations with their patients, referring to speciality counsellors or interprofessional teams to further address sexual health concerns.

Source: Sexuality and Menopause: Unique Issues in Gynecologic Cancer
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