Menopause and cancer: What women should know

Menopause often brings more than physical changes. It also may bring uncertainty about cancer risks and cancer prevention.

Below, I’ve compiled some of the questions I frequently hear from patients about menopause and cancer. I hope these answers will help other women start informed conversations with their doctors about menopause-related concerns.

How does menopause affect a woman’s cancer risk?

Menopause does not cause cancer. But your risk of developing cancer increases as you age. So women going through menopause have a greater chance of developing cancer because they’re older.

How does the age at which a woman starts menopause affect her cancer risk?

Starting menopause after age 55 increases a woman’s risk of breast cancer and endometrial cancer. That’s probably because she’s been exposed to more estrogen. During a woman’s menstrual cycle, estrogen stimulates the uterus and breast tissue. So the more menstrual periods a woman has, the longer these tissues are exposed to estrogen.

Women who start menopause later also may have an increased risk of ovarian cancer possibly because they have had more ovulations.

Some women receive hormone therapy (HT) to cope with menopause symptoms. How safe is HT?

I encourage women to try safer alternatives before using HT. Postmenopausal use of HT increases a woman’s risk of breast cancer.

The Women’s Health Initiative showed that women who took combined hormone therapy (estrogen and progestin) had a bigger risk of breast cancer. There also may be a higher risk for women taking estrogen alone, but study results on this risk are still inconclusive.

Some studies also suggest that using HT after menopause may slightly increase ovarian cancer risk. Generally, the longer you use hormone therapy, the more your cancer risk appears to increase.

That said, one study actually showed that women who used HT had a smaller risk of colorectal cancer. But the increase in breast cancer risk is still bigger than the decreased risk for colon cancer. So HT risks tend to outweigh any benefits.

Speak with your doctor before using hormone therapy. Make sure you understand all the benefits and harms before you start taking them.

What are some safer HRT alternatives that you recommend?

Even small lifestyle changes can make a big difference. For instance, you may have terrible hot flashes if you drink coffee before showering. But your hot flashes may not be nearly as bad if you try drinking coffee after showering.

Some safe and healthy ways to manage menopause symptoms include:

  • Exercising regularly
  • Increasing calcium and vitamin D in your diet
  • Reducing stress
  • Getting enough sleep
  • Avoiding hot flash triggers like coffee, tea and alcohol
  • Quitting smoking

If lifestyle changes don’t help, women may wish to talk to their doctor about anti-depressants. Certain anti-depressants tend to reduce frequency and intensity of hot flashes. And they curb moodiness and irritability associated with menopause, so they make help women who use them feel better.

Anti-depressants don’t help with a common menopause symptom — vaginal dryness, though. Many over-the-counter moisturizers and lubricants can help with this. But they only work if you use them on an ongoing basis.

What can women do to reduce their cancer risk during and after menopause?

The same ways you reduce your cancer risk before menopause: exercise, eat a healthy diet, don’t smoke and avoid secondhand smoke, and maintain a healthy body weight.

Research shows that gaining weight after menopause increases a woman’s risk of breast cancer, but losing weight after menopause can actually reduce your risk.

Therese B. Bevers is medical editor of The University of Texas MD Anderson Cancer Center’s Focused on Health.

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  • Here it comes like a big dead end

    Bring on the ovary transplants. Menopause may be a “natural” event, with evolutionary advantages for the species overall, but it is not so good for the individual.

    I view it as a pathological process off aging, bringing with it cognitive decline, accelerated heart disease, ruination of skin and figure, sexual impairments of assorted variety, and miserable symptoms.

    I would be glad to exchange a few miserable years on the back end for a few good ones on the front end.

    My plan is all the restoration from hormone therapy I can get, staying away from any pill or premarin regimen. If at any point an estrogen only therapy becomes suitable for my situation, I will seek it out.

    I plan to begin hormone therapy when peri-menopause begins to segue into the real deal, as lesser benefits and greater risk appear to be associated with delay.

  • Finn

    Can you point me toward evidence supporting the claim that the actions on your bulleted list actually reduce menopausal symptoms like hot flashes? The list looks more like general health promotion tips. From what I’ve read, my understanding is that exercise does not reduce either intensity or frequency of hot flashes and may actually increase sweating during them, and that calcium and vitamin D are recommended for bone strength, not hot flashes. I’ve never read anything linking hot flashes to sleep duration, except in the sense that hot flashes are often sleep-disrupting.

    In terms of treatments, antidepressants aren’t the only option. Neurontin (gabapentin) and the antihypertensive clonidine also reduce hot flash frequency and intensity for some women. Either can be a better option for women who don’t want or need to have their moods altered.

  • kitty

    Why is that that most articles on menopause forget to mention POF? A single sentence saying that this article applies to normal menopause at average menopausal age would be nice.

    For those of us who had premature ovarian failure the research is lacking. There is good information on NIH website, but in my experience dealing with doctors when I was still in my 30s is that most are clueless when it comes to POF – both in diagnosing it (months and often years’ delays in diagnosis in spite of repeated complaints are common) and HRT. There is also no information whether given additional risks of women with pof who even with HRT until 50 still had less exposure to estrogen then normal women it might be OK to continue on HRT for a little longer. So OK, doctors gave me HRT (same dose that older women were getting which is about half of normal full replacement dose) at 38… but I didn’t have enough estrogen starting from 32 if I go by symptoms. By 34, I had 3-months breaks in periods which got both more common and longer.

    BTW, premature menopause support group even had some 20-something women whose doctors’ knee jerk reaction post-WHI was to deny them HRT. Did these doctors stopped and think that being without hormones at 20-something has risks too and that not a single woman in WHI study was younger than 50.

    I am not even talking about lack of sensitivity. POF diagnosis is devastating, but so many doctors just treat is as no big deal, like “you are in menopause”, here is a booklet about “the change” addressed to 50-something women. One woman had a doctor who told her “at least you don’t need to worry about birth control any more”.

  • SarahW

    Kitty, that’s shocking, especially since there is no evidence that HRT in POF increases cancer risk, and there is evidence it does not.

    The appalling misuse of that premarin study, which included women who started HRT very late when risk/benefit was skewed, and which only considered the combination therapy (with analog estrogen.)

    I look forward to the day when physicians treating women stop working based on irrational conclusions derived from that study.

  • http://Www.twitter.com/alicearobertson Alice

    I look forward to the day when physicians treating women stop working based on irrational conclusions derived from that study. [end quote]

    The foundation of the research doctors use is faulty. I am friends with two research doctors and even they get confused…and they are both genuinely concerned about women. When my friend tells me something found in research..they will snidely tell me they know I can find 500 other research papers to disagree. It’s a jungle out there as far as research is concerned. The truth isn’t always valued and doctors struggle to find it just as we do. I wish it were easier to find out the agendas of the researchers….and what type of research rules were followed…who financed it…etc. Comparing research can be nightmarish. Two other doctors I know gave up research. One said the vast amount of scrutiny the government placed him under…the constant rewrites…the removal of pertinent information drove him crazy. He felt it was a moral failure to man.

    There is an OB who blogs for Dr. Oz. She challenged Suzanne Somers on Oprah (it”s online at her site). After hearing about natural hormones, and finding a doctor who prescribes them..then finding a compounding pharmacy and getting all hyped up that you will look marvelous, have more energy….even perky breasts…..a real fountain of youth….this OB challenged them. It seems you can go to an OB and get the same stuff in pill form. The compounding pharmacy can mix it with cream and you usually pay out of pocket…but it was just hormones creatively mixed under the guise of being natural. Hormones with some nice bells and whistles…