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Jessica was prescribed hormone replacement therapy (HRT) in October 2017. We spoke to Jessica and Debby Holloway, a Gynaecology nurse consultant from Guys and St Thomas’ hospital, about early onset menopause caused by cervical cancer treatment, and the potential benefits of going on HRT.
Jessica: "In May 2017, I had chemotherapy and radiotherapy (external and internal) to treat recurring cervical cancer. At the end of July, after the treatment had finished, I started to have mood swings for no apparent reason and there was no warning. I could be sat watching the TV and that would be it – my mood would just change. I would go from happy to angry in the blink of an eye and the hot flushes were awful. My face would start burning up and then I’d be boiling. I knew these effects were because the treatment had caused early onset menopause."
Debby: "A side effect of having chemotherapy and radiotherapy is that it can stop the ovaries from working properly, meaning that a woman like Jessica can be put into early menopause.
The ovaries contain follicles which make eggs. If these are damaged, the hormone system will not be able to function properly. This is because oestrogen levels drop, and in combination with other hormonal changes this can cause menopausal symptoms.
There are many different symptoms of menopause and they affect everyone differently. When the menopause is triggered early because of medical reasons, for example with some cancer treatments, then the symptoms can be more severe than if it was a normal or natural menopause.
As well as having symptoms of early menopause, there are also changes that mean that women are at increased risk of heart problems and a lower bone density (osteoporosis). Due to the lack of oestrogen, this can lead to fractures if they fall."
Jessica: “I already knew of HRT, as it was mentioned when I first met my consultant and we discussed which treatment I would be receiving.
I spoke to my consultant, who advised that I see my GP about HRT. I was quite conflicted about HRT – I knew that it would be for the best for me being quite young, but at the same time it made everything so real. It meant that I did have cancer, that I was going through the menopause and I was never going to have any more biological children, and I found that quite difficult to deal with.
My GP described HRT to me as a hormone replacement, and that the early onset menopause meant I was losing my own hormones, so the HRT would replace them.”
Debby: "HRT is hormones given to replace what the body would have made when having a menstrual cycle. In this case it is replacement, just as if there was issues with the thyroid that hormone would be replaced.
HRT can be oestrogen only if you have had a hysterectomy or have an IUS (mirena) in situ and, combined HRT, which is oestrogen and progestogen, if the womb remains.
It can be given as transdermal (across the skin) in the form of patches or gel, or as tablets. Depending on the cause of the menopause and whether there is any bleeding, it can be given as continuous HRT with both hormones so that there is no bleeding, or as sequential HRT with both hormones but given to mimic the cycle.
In some cases, women may also need to have vaginal oestrogen as well as HRT, or by itself if the main issue is vaginal dryness, and testosterone gel if there is an issue with their sex drive (libido)."
Jessica: “I did discuss some side effects with the GP. My doctor was very good with me throughout the whole process.”
Debby: "If HRT is taken as a replacement prior to the age of menopause, then there is no increased risk in breast cancer over and above the background risk.
Side effects can be related to the way the HRT is given:
These can all depend on the type, amount and way HRT is taken and mostly they will settle after the first few months. Sometimes there can be bleeding and this again should settle, but if it does not it needs to be discussed with your healthcare professional."
Jessica: “I first tried the patches and although my mood swings subsided a little, I found remembering to change them every few days didn’t go well for me. I went back to the GP and we decided to go with taking a tablet every day. I find this a lot easier. I leave it in my dressing table and take it every morning as I’m getting ready.
“I started on a 1mg tablet, which seemed to work. My mood swings happened less often and I stopped getting hot flushes. It made everyday life easier – I wasn’t becoming irritated at everything, I wasn’t having to try to cool myself down every hour or so. It also meant that my husband and I argued less... I felt so sorry for him, he definitely got the brunt of it as not only did we argue almost every day, we were never close.
Having the HRT helped me to be “normal”. The arguing wasn’t as often and we became close. But then the hot flushes started to come back and the mood swings started again, so I went back to the GP and I was prescribed 2mg. So far, it has been great. I’m a lot happier, and my husband and I get along a lot better.
Before HRT, I distanced myself from people because I felt I was difficult to be around. 1 minute I was fine, the next I felt like I wanted to explode. Being on HRT I’ve started to be more outgoing again, going to see friends and wanting to be around people.
Day to day life is a lot better now. I’m not as emotional, I’m not biting everyone’s heads off, and I have a lot more motivation to get stuff done. It’s not an overnight fix and it does take a little while to work. If you feel like it’s not working, go back to see your GP because you could need a different dose, and make sure the form of HRT you use is right for you. It does make a difference! I’m a different person on HRT and it hasn’t just benefited me, it’s benefited my husband and children as well.”
Debby: "There are tablets, patches, gels, and a combination of all of three. There are some reasons why different ones may be suggested to some women. For example, all of the tablets have lactose so if someone is intolerant then patches are better.
Patches or gels have a lower risk of blood clots, but this should not impact too much on the younger woman."
Debby: "HRT is the only treatment that can help with all of the symptoms of the menopause, and protect your bones and heart for the future. We normally suggest staying on one HRT for at least 3 months to assess the benefits or the side effects. Some younger women may need more HRT and have to increase the dosage of the oestrogen to feel more like themselves. Some may need additional testosterone and vaginal oestrogen.
Talk to your healthcare professional if you’re concerned about symptoms. Although it may take a couple of changes to find the right HRT for you, once this has been achieved it can make life easier."
We have more information about early menopause and HRT on our website here.
We also host support days for women living with and beyond cervical cancer, where we run a series of workshops. We normally have one on early menopause and HRT, so check out them here – we’d love to see you there.
Alternatively, contact The Daisy Network, who specialise in supporting women experiencing early menopause.
Categories: cervical cancer