Menopause worse in cancer survivors

Women who survive cancer have more frequent, severe, and troubling hot flashes than women with menopausal symptoms, according to a recent study. But, surprisingly, the cancer survivors fare better psychologically and report a better quality of life than the women without cancer. Also, cancer survivors have about the same levels of sexual activity and function.

This study, published in Menopause (2013; doi: 10.1097/GME.0b013e3182976f46), is the first large-scale, clinic-based study to compare these groups of women using standard, validated questionnaires. It included 934 cancer survivors (about 90% survived breast cancer) and 155 participants without cancer who were patients at King Edward Memorial Hospital in Western Australia. The questionnaires, including the Green Climacteric Scale and Fallowfield's Sexual Activity Questionnaire, assessed hot flashes and other menopause-related symptoms and sexual function.

For the cancer survivors, hot flashes were much more frequent and severe. Among cancer survivors, 76% percent reported having hot flashes in the past 24 hours, compared with 54% of women without cancer. And 60% reported those hot flashes were severe or very severe, compared with 40% of the women without cancer. The authors pointed out that menopausal symptoms also seem to persist much longer in the cancer survivors, who often complained of menopausal symptoms many years after their cancer diagnosis.

But the study also offered some surprising findings: The cancer survivors were less troubled by psychological and physical symptoms and reported better quality of life than the women without cancer. In fact, the cancer survivors were less likely to have severe mood swings or sadness and reported significantly better social and family well-being. In addition, the cancer survivors had about the same levels of sexual activity and function, and just about as many (49%) reported severe vaginal dryness as women without cancer (47%). However, the survivors were more likely to attribute their sexual inactivity to "a physical problem that makes sexual relations difficult or uncomfortable."

The authors suggested that this study's surprising findings might be accounted for by the fact that this study included women who may have undergone cancer therapy years before. The cancer survivors' better emotional and social well-being may be the result of the good social and psychological support available for cancer survivors. Their similar rate of sexual problems did not mean the cancer survivors fared well—the rates were high in both groups.

The executive director of the North American Menopause Society, Margery Gass, MD, commented, “Both expected and surprising, these results highlight that all menopausal women, including cancer survivors, need effective treatment options for their hot flashes and sexual symptoms.”
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