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Speak to a specialist nurse on Freephone 0800 0087 054 A SUDDEN CHANGE At the end of last year The National Institute for Health and Care Excellence (NICE) published its first guidelines on managing the menopause. We look at how its advice impacts women who are dealing with a surgically-induced menopause. Once a largely taboo subject, celebrities Angelina Jolie and Davina McCall have been sharing their experience of the menopause: both finding positives as they move into the next stage of their lives. In media newspaper articles Angelina was reported as feeling more grounded with the change - hers brought on by preventative surgery for ovarian cancer, and in Good Housekeeping Davina McCall, was quoted as saying although difficult at times, she is finding the experience of a natural menopause “incredibly positive”. Not all women will be finding the transition as straightforward, particularly those having to deal with the effects of the surgery that caused it and an ovarian cancer diagnosis to boot. For those coping with a surgical menopause the symptoms can be, although not always, harsher than one brought on naturally, as the body is hit with an instant cessation of oestrogen production, rather than a normal gradual reduction. But Dr Heather Currie, a gynaecologist in Dumfries, chair of The British Menopause Society and managing director of Menopause Matters Ltd, says that every woman will react differently to the menopause regardless of whether it is one brought on surgically or naturally. But she warns women need to be emotionally prepared: “If ovaries are removed, the symptoms can happen very quickly with the sudden drop in oestrogen. It has been known to happen on the day of the procedure taking place. And the symptoms can be more severe than a natural menopause. The bottom line is though we don’t know why some women suffer more from the menopause than others.” “For all women approaching menopause, the At melting point. There’s help at hand for hot flushes and other symptoms brought on by a surgicallyinduced menopause. significant thing is to have a good diet, not be overweight, to take exercise and to avoid caffeine, smoking and alcohol which can aggravate the symptoms.” But there is help at hand and the NICE guidelines outline the treatments which should be considered for the main symptoms of sweats and hot flushes, low mood, vaginal dryness and loss of libido. Often women who have a surgical menopause will be given hormone replacement therapy (HRT). HRT is used to prevent menopausal symptoms and to reduce the increased risks of osteoporosis and heart disease seen in women who have a premature menopause, before the age of 51. And says Dr Currie: “The benefits outweigh the risks for most women under the age of 60 or within 10 years of the menopause for whom the risks are small.” Some women though will choose not to take HRT or be advised against it, for instance, if they have had breast cancer or their ovarian cancer tumour had oestrogen receptors on it. In the latter case, women might be able to have vaginal oestrogen. Ovacome’s support line nurse Ruth Payne says it is a good idea for any woman going into a surgical menopause, regardless of her age, to ask her GP for a DEXA (dual X-ray absorptiometry) scan, as a baseline to check bone density. Treatment can be given with drugs to improve bone density and advice on diet and exercise can help to prevent any future loss. The NICE guidelines say that if HRT is suitable for you, your GP should discuss the benefits and risks, both within the next five years and beyond. 10 Follow Ovacome on Twitter and Facebook or visit www.ovacome.org.uk
ovarian cancer charity For women suffering from hot flushes and sweats, NICE says they should also be given information on: – non-hormonal treatments, such as a drug called clonidine; – cognitive behavioural therapy (CBT), a psychological therapy that helps people to manage the way they think and feel. – non prescribed treatments, with some women finding St John’s-wort helpful. However, the ingredients of products containing St John’s-wort may vary, their effects are uncertain and it may interfere with other drugs, including those used to treat breast cancer, for example tamoxifen. Alternative therapies such as black cohosh and isoflavones can reduce hot flushes and night sweats. However ingredients of these products may vary and their safety is unknown. They may interfere with other medicine. For women suffering low mood or anxiety: – HRT may help. – As might CBT (cognitive behavioural therapy). – Antidepressant drugs called SSRIs and SNRIs can help if you haven’t been diagnosed with depression. Lack of interest in sex: If HRT doesn’t help, you might be offered a testosterone supplement. At the time of the publication of the NICE guidance (November 2015), testosterone supplements were not licensed for use in women. For more information about licensing and ‘off‐label’ use of medicines visit NHS Choices. Vaginal dryness: You should be offered vaginal oestrogen, which is put directly into the vagina as a pessary, cream or a vaginal ring. You can use vaginal oestrogen for as long as you need to, even if you are already using HRT. Moisturisers and lubricants can also help. If vaginal oestrogen doesn’t help to start with you may be offered a higher dose. • To read the full NICE guidelines visit www.nice. org.uk/guidance/ng23/informationforpublic For more advice on the menopause phone Ovacome’s Freephone nurse led support line on 0800 0087 054. Article reviewed by Sean Kehoe MA(Ox) MD DCH FRCOG, Lawson Tait Professor of Gynaecological Cancer, University of Birmingham and Senior Research Fellow, St Peter’s College, Oxford. How I coped with my surgical menopause Rachael Cox: over the worst of the menopause. For 37-year-old Rachael Cox from Kingston upon Thames, dealing with the surgical menopause was one of the hardest things she faced following her diagnosis of stage 3c ovarian cancer in April 2013. And two years on, although over the worse, she still has hot flushes usually once a day, but they are emotionally triggered, no longer out of the blue as before. “I wish I had been given the heads up. I suffered horrifically,” says Rachael who recalls putting on 11 kilos of weight in three months, having over 20 hot flushes in a day and painful intercourse, which she says had “a huge impact sexually” with lubricants being a passion killer. Rachael was advised against taking HRT because “of the hormonal impact” maybe causing a recurrence of her type of tumour. Wearing loose clothing and stints on starflower oil and anti-depressants helped, but the biggest support for her was the Maggie’s cancer centre in Hammersmith where experts talked her through what was happening. “In the end it was just time really that got me through,” says Rachael. A sudden change 11
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