Stage One
Perimenopause
This encompasses the years preceding the menopause which can begin in a woman’s 40’s or sometimes even earlier. It occurs as the store of eggs that a woman is born with declines. This in turn results in lower hormone levels being secreted by the follicles in the ovaries. As the hormones fluctuate, symptoms come and go and periods change in pattern. Common early symptoms include mood changes, anxiety, irritability, brain fog, lack of concentration and loss of self esteem. These often come much earlier than other more recognisable physical symptoms such as hot flushes or night sweats.
Stage Two
Menopause
The average age for women to hit the menopause in the UK is 51. Menopause is a retrospective diagnosis, and can only be confirmed 12 months after a woman’s final period has occurred. At this stage, the ovaries have finally run out of eggs, resulting in a dramatic fall in all three important female hormones, estrogen, progesterone and testosterone. Hormone receptors are located throughout the body; your brain, skin, bones, heart, musculoskeletal system, joints, urinary tract and genital area. Varying hormone levels can affect any or all of these parts of the body, therefore causing a wide range of different symptoms.
Early menopause is diagnosed if menopause occurs between the ages of 40 and 45.
One percent of women are diagnosed with menopause under the age of 40. This is termed premature ovarian insufficiency or ‘POI’. 1 in 1000 experience it under 30.
Menopause is usually a natural event, but can also be surgically induced, following removal of the ovaries, or secondary to medical treatment such as chemotherapy or radiotherapy.
Stage Three
Postmenopause
This is the time after a woman’s periods have ceased for 12 consecutive months. This stage continues for the rest of a woman’s life. With western life expectancies, many women will be post menopausal for a third of their lives.
Whilst many women may continue to experience menopausal symptoms for 4 or 5 years after menopause, the long term implications of hormone deficiency particularly on heart, bone and brain health will continue for the rest of their lives.
Menopause in cancer patients can be a complex issue, as cancer treatments such as chemotherapy, radiation therapy, and surgery can affect the ovaries and lead to premature menopause or early onset of menopausal symptoms. It's important for cancer patients and survivors to have access to reliable and accurate information about menopause and its management.
For women who have had breast cancer, the decision to start HRT after cancer treatment is particularly complex, as HRT has been associated with an increased risk of breast cancer recurrence.
For women who have had other types of cancer, such as ovarian cancer or endometrial cancer, HRT may be recommended to manage menopausal symptoms, but the timing of starting HRT will depend on individual factors and the patient's overall health status.
When considering HRT after cancer treatment, it is important to weigh up the potential risks and benefits of the treatment, and to first explore alternative strategies for managing menopausal symptoms, such as lifestyle changes, non-hormonal medications, and alternative therapies. Women who have had breast cancer should also consider the potential risks of HRT on breast cancer recurrence, and should discuss these risks with their healthcare provider, who can provide guidance and information to help women make an informed decision about whether or not to take HRT.
