If you’re a woman under 40, you’re probably not thinking about menopause. But for young women who have had cancer, treatment-induced ovarian failure – often referred to as “chemopause” – is a very realistic concern.
Listen in as Lynda Beaupin, MD explains that premature menopause is caused by a number of cancer treatments including chemotherapy, radiation therapy, surgical removal of the ovaries and hormone therapy. The most common cause is chemotherapy since some of the medications can cause irreversible damage to the ovaries.
Selected Podcast
Chemopause: Managing The Symptoms
Featured Speaker:
Learn more about Lynda Beaupin, MD
Lynda Beaupin, MD
Lynda Beaupin, MD, is the Director of the Young Adult Program, Roswell Park Comprehensive Cancer Center.Learn more about Lynda Beaupin, MD
Transcription:
Chemopause: Managing The Symptoms
Bill Klaproth (Host): Early menopause is a serious concern for young women with cancer often referred to as chemopause, which is treatment-induced ovarian failure. So, what can be done about it? Here to tell us more is Dr. Linda Beaupin, a fertility issues specialist at Roswell Park Comprehensive Cancer Center. Dr. Beaupin, thanks for your time. Can you explain chemopause more in depth?
Dr. Beaupin (Guest): Sure. I think for young women who definitely are under the age of 40 and not thinking of menopause at all, chemopause refers to when these young women who’ve had cancer, unfortunately, get treatment-induced ovarian failure, which is kind of the medical term for chemopause, which is really menopause happening earlier than we normally expect it to be.
Bill: And, what are the treatments that generally cause chemopause? I imagine chemotherapy is one of them. Are there other forms of treatment that can cause chemopause?
Dr. Beaupin: You’re right. I would say chemotherapy is probably the more common cause that would cause the effect on the ovaries to induce or cause premature menopause. But, really, certain chemotherapies definitely are more at risk of others. Radiation to your pelvis area, where your ovaries are housed, and certainly direct radiation to our female organs, that would affect it. And, of course, even surgery where your ovaries may have to be removed, that would also cause it. So, really in cancer treatment, any aspect of it, could potentially put a young woman at risk for chemopause.
Bill: And, is there a percentage of women that this happens to?
Dr. Beaupin: It’s hard to predict. Rather than saying what percentage of women are affected, I think we should look at certain diseases where the women who are affected by those cancer types are more likely to be affected. So, for instance, I think the population where they may have gynecologic cancers, ovarian disease, cervical cancer--anything in the female reproductive organ area, because oftentimes they may require surgery, and sometimes along with chemotherapy, and occasionally radiation--I would say those women are definitely at high risk, certainly because those primary organs are involved. There are certain types of chemotherapy that are used across many different types of cancer that can cause infertility. The class of chemotherapy agents that most likely cause this is alkylating agents. These chemotherapy drugs are used in many different diseases, so it’s hard to say. They’re used sometimes in leukemia. They are used in solid tumor types, such as sarcomas. They can be used for actually even in Hodgkin's lymphoma. And, I’d say the most common drug there would be cyclophosphamide and ifosfamide that are mostly used under this class of alkylating agents. And, then, when we’re talking about those chemo drugs it’s also dependent on how much of that drug they receive, but I certainly wouldn’t want young women to start automatically worrying if they receive this drug because it really is dose dependent, as well. This is where it’s really important to have that discussion with your oncologist and your cancer treating team to kind of guide you with how much did I receive of this medication to put me at risk of chemopause? And so, I think it’s hard to say what percentage of women are affected but more what diseases are we looking at that have a larger proportion of women who will be receiving these therapies that will put them at risk for this? The other one is, the radiation that I didn’t really talk about yet, but certainly young women who do need radiation to their abdomen, even if they’re trying to avoid the pelvic area with the reproductive organs, radiation does have a scatter field. We’ve gotten much more precise on our radiation fields. We do everything we can to avoid radiating areas that we do not want to have any radiation at all. But, certainly, that’s something to, again, talk with your treating team to talk about whether their radiation plan has put them at risk for this at all.
Bill: Well, that makes a lot of sense and thanks for explaining those to us. So, for a woman under 40 that does have cancer who wants to have children, as you said, it’s a good idea to talk with your physician about the options. Can you change the treatment, then, to try to make sure chemopause doesn’t happen?
Dr. Beaupin: Well, that definitely becomes tricky. What we’ve learned over all these years for these different diseases is what the best treatment is that we can offer to cure that disease. Certainly, while we focus so much on curing the cancer and we have come a long way, as well as needing a long way to go in certain diseases, adjusting them for the risk of infertility is hard to do. I think what we need to mostly consider is counseling our young women about the risks beforehand so that they know going into this what the risks are, what to expect afterwards, rather than finding all this out afterwards. While we do try to focus on what the symptoms are, and there are ways to alleviate those symptoms that come with chemopause, another important aspect is if it really does impact their chances of having children, which is really what chemopause does if you’re going into early menopause, these women who could be in their twenties and thirties, they really need to consider what their family planning options are. So, I do think we do focus on treatment and we always want to give the best treatment to cure that disease, really help our young patients understand what their risks are that are related to treatment, especially how it pertains to their ability to have children. And then, along with that, with chemopause, what symptoms they may have because of this earlier onset of their ovaries not functioning as well.
Bill: So, is chemopause permanent, then?
Dr. Beaupin: That’s a very good question. It can be permanent for some, and it can also be temporary. I’d say for a lot of people who are receiving chemotherapy, a lot of those regimens do kind of put a temporary pause on the reproductive organs because our hormones do get affected with chemotherapy and it may be a temporary thing. And depending, again, on which therapy someone has received and at what doses, that may be permanent or it could be temporary. Sometimes temporary is even up to nine months to over one year of everything getting back to normal.
Bill: Well, that’s good to know. What are the symptoms of treatment induced menopause?
Dr. Beaupin: I think they’re very similar to menopause and we’ll go through them because I think a lot of young women aren’t really thinking of them because they’re not thinking that menopause is going to happen to them until they’re in their fifties. So, they’re really - as we may have heard from other older women who’ve gone through this - hot flashes, night sweats, they have trouble sleeping, they certainly can have vaginal dryness or irritation and this may come out to be more of a problem when they’re trying to engage in sexual relations as that may be very uncomfortable or even painful. They may have more irritability as hormones do help with our emotions so they may have mood swings, and, so, it really runs a big range of symptoms. So really, if they have this onset of these symptoms that they never really felt before, and it may not be on their radar, they really need to discuss that with someone. And, they may actually be sensing that this may be just related to their chemotherapy, but, certainly, if it continues that is something they should really be able to bring up with their cancer doctor.
Bill: And, is there a way to manage the symptoms if a woman is in chemopause?
Dr. Beaupin: Certainly, depending on what the symptoms are, we certainly give tips as to how to alleviate them. So, you know, as we talked about even the hot flashes and the even night sweats that you can have which then can make someone more uncomfortable to fall asleep, really kind of knowing that those are some of the symptoms with chemopause. So, being aware of how you can dress maybe more appropriately. We’re learning that exercise and just diet and wellbeing are helping very much. Certainly, you can have vaginal and bladder irritation putting them at risk of infection, so drinking lots of water-- that helps. We’re learning that many methods that are more integrative such as mindfulness and mediation and yoga, they actually help with decreasing some of the stressors in our system and that helps alleviate some of these symptoms. Of course, there are medications. There are hormone replacement therapies that one can discuss with their treating doctor and provider, as maybe supplementing with hormones such as estrogen and progesterone can help with the symptoms that they’re having. Again, there are risks to this and how long one wants to be on them, so these are discussions really to be had with your treating doctor.
Bill: And, Dr. Beaupin, thank you so much for your time today, and if you could wrap it up for us. Why should someone choose Roswell Park Cancer Institute for their cancer treatment?
Dr. Beaupin: Well, here at Roswell we try our best to really take the whole patient into account. So, while we certainly focus on curing cancer and offering the best therapy for you and the disease that you are facing, we really are emphasizing the need to address the whole person. So, while we do talk about chemopause, we now have a clinic offered just specifically for women and young men of reproductive health who are having issues. So, for instance, women who are experiencing chemopause can now be seen at our oncofertility clinic. We deal with the symptoms that they may be having. We may actually help identify if they are experiencing chemopause and, depending on their symptoms, we can actually address them effectively and see what next steps we need to take. So, we really hope that this new service that we have, our oncofertility clinic, will benefit many of our patients and if anyone is interested they can always contact ask@rpci and they will direct you to our clinic.
Bill: Dr. Beaupin, great information. Thank you so much for sharing that with us. And for more information, just go to www.Roswellpark.org. That’s www.Roswellpark.org. You’re listening to Roswell Park Cancer Talk. I’m Bill Klaproth. Thanks for listening.
Chemopause: Managing The Symptoms
Bill Klaproth (Host): Early menopause is a serious concern for young women with cancer often referred to as chemopause, which is treatment-induced ovarian failure. So, what can be done about it? Here to tell us more is Dr. Linda Beaupin, a fertility issues specialist at Roswell Park Comprehensive Cancer Center. Dr. Beaupin, thanks for your time. Can you explain chemopause more in depth?
Dr. Beaupin (Guest): Sure. I think for young women who definitely are under the age of 40 and not thinking of menopause at all, chemopause refers to when these young women who’ve had cancer, unfortunately, get treatment-induced ovarian failure, which is kind of the medical term for chemopause, which is really menopause happening earlier than we normally expect it to be.
Bill: And, what are the treatments that generally cause chemopause? I imagine chemotherapy is one of them. Are there other forms of treatment that can cause chemopause?
Dr. Beaupin: You’re right. I would say chemotherapy is probably the more common cause that would cause the effect on the ovaries to induce or cause premature menopause. But, really, certain chemotherapies definitely are more at risk of others. Radiation to your pelvis area, where your ovaries are housed, and certainly direct radiation to our female organs, that would affect it. And, of course, even surgery where your ovaries may have to be removed, that would also cause it. So, really in cancer treatment, any aspect of it, could potentially put a young woman at risk for chemopause.
Bill: And, is there a percentage of women that this happens to?
Dr. Beaupin: It’s hard to predict. Rather than saying what percentage of women are affected, I think we should look at certain diseases where the women who are affected by those cancer types are more likely to be affected. So, for instance, I think the population where they may have gynecologic cancers, ovarian disease, cervical cancer--anything in the female reproductive organ area, because oftentimes they may require surgery, and sometimes along with chemotherapy, and occasionally radiation--I would say those women are definitely at high risk, certainly because those primary organs are involved. There are certain types of chemotherapy that are used across many different types of cancer that can cause infertility. The class of chemotherapy agents that most likely cause this is alkylating agents. These chemotherapy drugs are used in many different diseases, so it’s hard to say. They’re used sometimes in leukemia. They are used in solid tumor types, such as sarcomas. They can be used for actually even in Hodgkin's lymphoma. And, I’d say the most common drug there would be cyclophosphamide and ifosfamide that are mostly used under this class of alkylating agents. And, then, when we’re talking about those chemo drugs it’s also dependent on how much of that drug they receive, but I certainly wouldn’t want young women to start automatically worrying if they receive this drug because it really is dose dependent, as well. This is where it’s really important to have that discussion with your oncologist and your cancer treating team to kind of guide you with how much did I receive of this medication to put me at risk of chemopause? And so, I think it’s hard to say what percentage of women are affected but more what diseases are we looking at that have a larger proportion of women who will be receiving these therapies that will put them at risk for this? The other one is, the radiation that I didn’t really talk about yet, but certainly young women who do need radiation to their abdomen, even if they’re trying to avoid the pelvic area with the reproductive organs, radiation does have a scatter field. We’ve gotten much more precise on our radiation fields. We do everything we can to avoid radiating areas that we do not want to have any radiation at all. But, certainly, that’s something to, again, talk with your treating team to talk about whether their radiation plan has put them at risk for this at all.
Bill: Well, that makes a lot of sense and thanks for explaining those to us. So, for a woman under 40 that does have cancer who wants to have children, as you said, it’s a good idea to talk with your physician about the options. Can you change the treatment, then, to try to make sure chemopause doesn’t happen?
Dr. Beaupin: Well, that definitely becomes tricky. What we’ve learned over all these years for these different diseases is what the best treatment is that we can offer to cure that disease. Certainly, while we focus so much on curing the cancer and we have come a long way, as well as needing a long way to go in certain diseases, adjusting them for the risk of infertility is hard to do. I think what we need to mostly consider is counseling our young women about the risks beforehand so that they know going into this what the risks are, what to expect afterwards, rather than finding all this out afterwards. While we do try to focus on what the symptoms are, and there are ways to alleviate those symptoms that come with chemopause, another important aspect is if it really does impact their chances of having children, which is really what chemopause does if you’re going into early menopause, these women who could be in their twenties and thirties, they really need to consider what their family planning options are. So, I do think we do focus on treatment and we always want to give the best treatment to cure that disease, really help our young patients understand what their risks are that are related to treatment, especially how it pertains to their ability to have children. And then, along with that, with chemopause, what symptoms they may have because of this earlier onset of their ovaries not functioning as well.
Bill: So, is chemopause permanent, then?
Dr. Beaupin: That’s a very good question. It can be permanent for some, and it can also be temporary. I’d say for a lot of people who are receiving chemotherapy, a lot of those regimens do kind of put a temporary pause on the reproductive organs because our hormones do get affected with chemotherapy and it may be a temporary thing. And depending, again, on which therapy someone has received and at what doses, that may be permanent or it could be temporary. Sometimes temporary is even up to nine months to over one year of everything getting back to normal.
Bill: Well, that’s good to know. What are the symptoms of treatment induced menopause?
Dr. Beaupin: I think they’re very similar to menopause and we’ll go through them because I think a lot of young women aren’t really thinking of them because they’re not thinking that menopause is going to happen to them until they’re in their fifties. So, they’re really - as we may have heard from other older women who’ve gone through this - hot flashes, night sweats, they have trouble sleeping, they certainly can have vaginal dryness or irritation and this may come out to be more of a problem when they’re trying to engage in sexual relations as that may be very uncomfortable or even painful. They may have more irritability as hormones do help with our emotions so they may have mood swings, and, so, it really runs a big range of symptoms. So really, if they have this onset of these symptoms that they never really felt before, and it may not be on their radar, they really need to discuss that with someone. And, they may actually be sensing that this may be just related to their chemotherapy, but, certainly, if it continues that is something they should really be able to bring up with their cancer doctor.
Bill: And, is there a way to manage the symptoms if a woman is in chemopause?
Dr. Beaupin: Certainly, depending on what the symptoms are, we certainly give tips as to how to alleviate them. So, you know, as we talked about even the hot flashes and the even night sweats that you can have which then can make someone more uncomfortable to fall asleep, really kind of knowing that those are some of the symptoms with chemopause. So, being aware of how you can dress maybe more appropriately. We’re learning that exercise and just diet and wellbeing are helping very much. Certainly, you can have vaginal and bladder irritation putting them at risk of infection, so drinking lots of water-- that helps. We’re learning that many methods that are more integrative such as mindfulness and mediation and yoga, they actually help with decreasing some of the stressors in our system and that helps alleviate some of these symptoms. Of course, there are medications. There are hormone replacement therapies that one can discuss with their treating doctor and provider, as maybe supplementing with hormones such as estrogen and progesterone can help with the symptoms that they’re having. Again, there are risks to this and how long one wants to be on them, so these are discussions really to be had with your treating doctor.
Bill: And, Dr. Beaupin, thank you so much for your time today, and if you could wrap it up for us. Why should someone choose Roswell Park Cancer Institute for their cancer treatment?
Dr. Beaupin: Well, here at Roswell we try our best to really take the whole patient into account. So, while we certainly focus on curing cancer and offering the best therapy for you and the disease that you are facing, we really are emphasizing the need to address the whole person. So, while we do talk about chemopause, we now have a clinic offered just specifically for women and young men of reproductive health who are having issues. So, for instance, women who are experiencing chemopause can now be seen at our oncofertility clinic. We deal with the symptoms that they may be having. We may actually help identify if they are experiencing chemopause and, depending on their symptoms, we can actually address them effectively and see what next steps we need to take. So, we really hope that this new service that we have, our oncofertility clinic, will benefit many of our patients and if anyone is interested they can always contact ask@rpci and they will direct you to our clinic.
Bill: Dr. Beaupin, great information. Thank you so much for sharing that with us. And for more information, just go to www.Roswellpark.org. That’s www.Roswellpark.org. You’re listening to Roswell Park Cancer Talk. I’m Bill Klaproth. Thanks for listening.