In this two-part series, we will discuss both the physical and emotional impact of menopause that is caused by cancer treatment. Join us for Part 1, which explores the physical impact. For women who have not reached menopause naturally before their diagnosis, some cancer treatments can cause early or sudden menopause. Join Marisa Cortese-Peske, Nurse Practicioner at New York-Presbyterian/Columbia University Medical Center to learn more about which treatments are likely to lead to menopause, the difference between medical vs. surgical menopause, how to recognize symptoms, and much more! You’ll also hear directly from patients about their experience with cancer treatment-related menopause, and be given strategies to lessen your symptoms and improve your quality of life.

1. Marisa Cortese-Peske, Ph.D., FNP-BC
Gynecologic Oncology Nurse Practitioner
Columbia University
When Cancer Treatment Causes Menopause - The Physical Impact

2. Overview
• What is Menopause?
• Types of Menopause
• Menopause and Cancer
• Symptoms of Menopause
• Treatments for Menopausal Symptoms

3. Menopause
• By definition menopause is:
• When a women stops her period for 12 months.
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4. How does menopause happen?
• Aging Process
• Surgical Menopause
• Chemical Menopause
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5. Menopause and Cancer
• Breast Cancer
• Ovarian Cancer
• Endometrial Cancer
• Cervical Cancer
• Other Cancers
• Stem Cell Transplant Recipients This Photo by Unknown Author is
licensed under CC BY-ND

6. Menopause and Aging
• Natural Aging Process
• Decline in estrogen and progesterone
due to the loss of ovarian follicular function
and a decline in circulating blood
estrogen levels.
• Menopausal transition can be gradual,
usually beginning with changes in the
menstrual cycle.
• Typically happens between ages 45-55
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licensed under CC BY-SA-NC

7. Surgical Menopause
Surgical removal of both ovaries (bilateral oophorectomy)
• Performed, sometimes with hysterectomy
• Benign Disease – Ovarian Cysts
• Gynecological Cancers – Ovarian Cancer
• Risk reduction treatment in women with an
inherited increased chance of developing ovarian
cancer (BRCA 1 or 2)

8. Chemical Menopause
• Chemical menopause
• Temporary (and reversible) menopausal state created with the use medications
called Gonadotropin Releasing Hormone Analogues (GnRHa)
• a type of drug which acts on the pituitary gland in the brain to suppress
ovulation and production of ovarian hormones. (Lupron, Zoladex)
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9. Menopausal Symptoms
The following are common symptoms of
menopause:
• Irregular periods / Amenorrhea
• Vaginal dryness
• Hot flashes / Chills
• Night sweats / Sleep problems
• Mood changes
• Weight gain and slowed metabolism
• Thinning hair and dry skin
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10. Amenorrhea / Infertility
• Amenorrhea
• Absence of menstruation
• Infertility
• Inability to produce children
• Chemotherapy
• Radiation Therapy
• Surgery
• Endocrine Therapy
• Fertility Preservation

11. Fertility and Cancer
• Fertility Preservation
• Reproductive Endocrinologist – after diagnosis
• Egg Freezing
• Embryo Freezing
• Adoption
• Surrogacy
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BY-ND

12. Vasomotor Symptoms
• Vasomotor Symptoms
• Hot flashes
• Cold flashes
• Night sweats
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BY-NC-ND

13. Vasomotor Symptoms - Management
• Pharmacological Strategies
• Anti-depressants – Venlafaxine (Effexor)
• Anticonvulsants – Gabapentin (Neurontin)
• Non-pharmacological Strategies
• Weight control / Healthy Diet
• Cognitive Behavioral Therapy
• Complementary and alternative medicine
• Acupuncture
• Hypnosis
• Yoga / Relaxation

14. Genitourinary Symptoms
• Vulvar and Vaginal Atrophy
• Vaginal Dryness
• Dyspareunia (painful intercourse)
• Irritation of genital skin
• Pruritis (itching)
• Burning
• Vaginal discharge
• Soreness
• Psychosocial Effects
• Decreased Libido
• Changes in body image

15. Genitourinary Symptoms – Management
• Pharmacological Strategies
• Vaginal Lubricants / Moisturizers
• Water-based (Replens)
• Hyaluronic Acid Moisturizers (Revaree; Hyalo-Gyn)
• Vitamin E suppositories
• Vulvar lidocaine
• Non-pharmacological Strategies
• Cognitive Behavioral Therapy
• Healthy Diet
• Smoking Cessation
• Physical Exercise
• Vaginal Diliators

16. Genitourinary Symptoms – Management
• Vaginal CO2 Laser Therapy
• MonaLisa Touch
• Complementary and alternative medicine
• Acupuncture
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under CC BY

17. Osteoporosis
• Osteoporosis is
• Decrease in bone density (2.5 standard deviations)
less than peak bone mass.
• No symptoms.
• High risk for fractures
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18. Osteoporosis Prevention and Treatment
• Pharmacological Strategies
• Bisphosphonates (Zoledronic Acid – Zometa)
• Denosumab (Prolia)
• Non-pharmacologic Strategies
• Calcium and Vitamin D
• Weight bearing exercises
• Healthy diet and protein
• Smoking cessation
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BY-NC-ND

19. Cardiovascular Disease
• Cardiovascular Disease and Menopause is associated with a higher prevalence of
cardiovascular risk factors such as:
• Central adiposity
• Atherogenic dyslipidemia
• Glucose intolerance
• Arterial hypertension (AH)
• Non-alcoholic fatty liver disease (NAFLD)
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20. Cardiovascular Disease Prevention
• Non-pharmacological Strategies
• Mediterranean diet
• Regular exercise
• Smoking cessation
• Alcohol restriction
• BP should be lowered to <140/90 mm Hg
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21. Musculoskeletal Symptoms
• Patients may experience the following symptoms especially is taking medications such
as aromatase inhibitors.
• Arthralgias
• Myalgias
• Arthritis
• Tendinitis
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22. Musculoskeletal Symptoms
• Pharmacological Strategies
• Duloxetine (Cymbalta)
• Vitamin D
• Non-pharmacological Strategies
• Aerobic exercise
• Walking
• Aquatic exercise
• Complementary and alternative medicine
• Acupuncture
• Yoga

23. Weight Gain
• Weight gain can cause the following:
• Poorer cancer prognosis
• Comorbidites
• Fatigue
• Functional decline
• Decrease in quality of life

24. Weight Gain
• Interventions for a healthy weight are:
• Physical exercise
• Healthy diet
• Cognitive behavioral therapy
Currently in clinical trials – sleeve gastrectomy and severe obesity in breast cancer
patients***

25. Conclusion
• Today we reviewed the following:
• Defining Menopause
• Types of Menopause
• Menopause and Cancer
• Symptoms of Menopause
• Treatments for Menopausal Symptoms

26. Thank you for your time.

27. Questions and Answers

28. References
• Abel, M. K., Morgan, T., Othieno, A., Angeles, A., & Goldman, M. (2022). Gynecological management of the breast
cancer survivor. Best Practice &Amp; Research Clinical Obstetrics &Amp; Gynaecology, 82, 69–80.
https://doi.org/10.1016/j.bpobgyn.2022.01.013
• Anagnostis, P., Lambrinoudaki, I., Stevenson, J. C., & Goulis, D. G. (2022). Menopause-associated risk of
cardiovascular disease. Endocrine Connections, 11(4). https://doi.org/10.1530/ec-21-0537
• Franzoi, M. A., Agostinetto, E., Perachino, M., Del Mastro, L., de Azambuja, E., Vaz-Luis, I., Partridge, A. H., &
Lambertini, M. (2021). Evidence-based approaches for the management of side-effects of adjuvant endocrine therapy
in patients with breast cancer. The Lancet Oncology, 22(7), e303–e313. https://doi.org/10.1016/s1470-
2045(20)30666-5
• Lobo, R. A., & Gompel, A. (2022). Management of menopause: a view towards prevention. The Lancet Diabetes
&Amp; Endocrinology, 10(6), 457–470. https://doi.org/10.1016/s2213-8587(21)00269-2
• López, D. M. L. (2022). Management of genitourinary syndrome of menopause in breast cancer survivors: An update.
World Journal of Clinical Oncology, 13(2), 71–100. https://doi.org/10.5306/wjco.v13.i2.71