Menopause and Cancer Risk and TreatmentThis section has been reviewed and approved by the Cancer.Net Editorial Board, 4/11
- Women who have been through natural menopause are at greater risk for developing cancer because they are older, which is a risk factor for cancer.
- Some cancer treatments may cause menopause or menopausal symptoms in women and menopausal-like symptoms in men.
- Postmenopausal hormone therapy may increase a woman’s risk of cancer.
Menopause occurs when a woman’s ovaries stop producing eggs; her menstrual periods become irregular, then stop completely; and her body decreases production of the hormones estrogen and progesterone. It begins during a woman's mid-40s or early- to mid-50s. It can also begin before a woman’s 40s if cancer treatment has stopped the ovaries from working (called premature menopause).
The symptoms of menopause include hot flashes, night sweats, vaginal dryness, sleeplessness, decreased sex drive, and mood swings. Learn about managing menopausal symptoms.
Menopause and cancer risk
A woman who began menopause after age 55 has an increased risk of ovarian, breast, and uterine cancer. This risk is greater if a woman also began menstruating before age 12.
A woman who menstruates longer than normal during her life is exposed to more estrogen and has more ovulations. Excess exposure to estrogen increases a woman’s risk of uterine and breast cancers, and having a greater number of ovulations increases a woman’s risk of ovarian cancer.
Does cancer treatment cause menopause or menopausal symptoms?
Some cancer treatments may cause menopause or menopausal symptoms. Menopause caused by medical treatment is called medical (or surgical) menopause. The symptoms of medical menopause may be worse because the decrease in hormones happens quickly. Even if cancer treatment does not cause menopause immediately, it may cause menopause to start sooner.
The following cancer treatments may cause menopause:
Oophorectomy (surgical removal of the ovaries). This type of surgery is used to treat or prevent ovarian, uterine, and vaginal cancers. It causes menopause immediately because the source of estrogen and progesterone is removed.
Radiation therapy or chemotherapy. Radiation therapy to the pelvis and chemotherapy that damages the ovaries can cause early menopause. Menstrual periods may return for some younger woman after treatment, but women older than age 40 are less likely to have their menstrual periods return.
Hormonal therapy. Hormonal therapy is used to treat breast cancer that is estrogen receptor- and/or progesterone receptor-positive, meaning that cancer uses estrogen and/or progesterone to grow. Hormonal or anti-estrogen therapies include the aromastase inhibitors—including anastrozole (Arimidex), letrozole (Femara), exemestane (Aromasin)—and tamoxifen.
The drugs tamoxifen (Nolvadex) and raloxifene (Evista) are used to reduce the risk of breast cancer for women who have been treated for breast cancer or who have a higher risk of breast cancer. The side effects of these drugs are similar to the symptoms of menopause.
Women taking hormonal therapy who have not been through menopause may have lighter and fewer regular menstrual periods, or their menstrual periods may stop completely. A woman’s menstrual periods may come back after hormonal therapy ends, but this is less likely for women who are closer to their natural menopausal age. Menopausal symptoms may come back for women taking hormonal therapy who have already reached menopause.
Men with prostate cancer who receive hormonal therapy or have their testicles removed may also experience symptoms similar to menopause. These include hot flashes, irritability, decreased sex drive, fatigue, osteoporosis (thinning of the bones), and erectile dysfunction (inability to have an erection).
Can the treatment of menopausal symptoms increase my risk of cancer?
The Women’s Health Initiative study found that women taking combined hormone therapy (also known as postmenopausal hormone therapy or hormone replacement therapy) to manage menopausal symptoms may have increased risk of breast cancer. Combined hormone therapy is a combination of estrogen and progestin (a form of progesterone made in a laboratory). It is used to help women cope with menopausal symptoms and prevent osteoporosis and heart disease. Hormone therapy with estrogen alone is only given to women who have had a hysterectomy (the removal of the uterus) because estrogen increases the risk of uterine cancer.
The Women’s Health Initiative also found that women taking combined hormone therapy had an increased risk of heart attack, stroke, and blood clots. However, they had a decreased risk of colorectal cancer and bone fractures. Because of the increased risks, many doctors recommend that women do not take combined hormone therapy or only take low doses for a short time. Combined hormone therapy is not usually recommended for women with a history of breast cancer or those who have an increased risk of breast cancer.
Recent research also showed that women who received combined hormone therapy have a higher risk of dying from non-small cell lung cancer (NSCLC) if they develop the disease. However, woman in the study taking combined hormone therapy were not more likely to develop NSCLC than women who were not taking combined hormone therapy. The study also showed that the risk of dying from lung cancer was higher for women with NSCLC who smoke and take combined hormone therapy.
Research on combined hormone therapy is controversial and ongoing. The risks and benefits of the treatment are different for each woman. Be sure to talk with your doctor about the benefits and risks before deciding to receive combined hormone therapy.
Emotional and Physical Matters
What to Know: ASCO’s Guideline on Hormone Therapy for Advanced Prostate Cancer
National Institute on Aging: Menopause
National Cancer Institute: Menopausal Hormone Replacement Therapy Use and Cancer
National Institutes of Health: Menopausal Hormone Therapy Information