Every woman who lives long enough will reach menopause, the time in life when menstrual cycles have stopped. You’ll receive a menopause diagnosis once you have gone a full year without having a menstrual period.
The lead-up to menopause, known as
perimenopause, is the time when the body begins to shut down reproductive capabilities. Hormonal changes contribute to symptoms such as hot flashes, weight gain, and
sleep trouble.
By the time a woman reaches menopause, estrogen levels are low. Without estrogen’s protective effects, postmenopausal women face
increased risks of certain health conditions, including heart disease, bone thinning, and other health issues.
Women should know that once they reach menopause, their chances of developing ovarian or endometrial cancer may be higher too. For example, a study found that early menopause may be a significant risk factor for cancers of the cervix, uterus, and ovaries.
Having more uninterrupted ovulations over the course of a lifetime may be linked to an increased risk of ovarian cancer, according to a review.
And
hormone exposure during hormone replacement therapy (HRT) may contribute to a person’s ovarian cancer risk.
However, older age is the primary risk factor for many different types of cancer.
Taking combination birth control pills (those that provide both estrogen and progestin) can reduce a woman’s risk of ovarian cancer, with longer-term usage leading to greater ovarian cancer risk reduction. Discuss the pill with a clinician, who can help you weigh the benefits and risks, as it can also lead to a slight increase in risk for heart attacks, stroke, and deep vein thrombosis.
There is currently no medical recommendation to limit a woman’s number of ovulations to reduce a later risk of cancer.
Your risk for most types of cancer increases as you age. In fact, older age is the most important risk factor for cancer overall.
According to the National Cancer Institute, the median age for a cancer diagnosis is 67 years, according to the most recent statistical data.
The
average age of menopause is 52 years.
”Menopause itself does not cause cancer. However, as women get older, their risk for many types of cancers goes up,” says JoAnn Pinkerton, MD, a professor of obstetrics and gynecology at the University of Virginia Health System in Charlottesville and an executive director emerita of the North American Menopause Society. “This means women after menopause have a higher chance of developing cancer, mainly because of their age.”
Going through menopause later may confer health benefits, including improved bone strength, a lower risk of heart disease, and more years before other effects of low estrogen, like memory issues, low libido, and reduced urinary control, kick in.
But research also shows that having more menstrual cycles throughout your lifetime could increase your risk of certain cancers.
“Women who have a late menopause, after age 55, have a higher risk of breast and uterine cancer. This is because they are exposed to estrogen for a longer time, which can fuel these cancers,” states Dr. Pinkerton. Their risk of ovarian cancer is also a bit higher, possibly because they have had more ovulation cycles.”
During a woman’s menstrual cycle, her uterus and breast tissue have more exposure to estrogen. And more menstrual cycles throughout a woman’s life means more estrogen exposure, which could contribute to cancer risk.
For example, women who start their periods before 11 years of age have a risk of breast cancer that’s between 15 and 20 percent higher than those who start their periods at 15 years of age or higher.
And in a pooled analysis of data from 400,000 women, for every year older a woman was when she she reached menopause, her breast cancer went up by around 3 percent.
However, according to one study, the risk of gynecological cancers, such as ovarian and cervical cancer, increases the earlier a woman starts to go through menopause. Women who went through menopause at the average age (50 to 55 years) had the lowest cancer risks, whereas those with a higher risk went through menopause in their thirties, which clinicians consider to be abnormal. This means that other processes might be contributing to increased cancer risk in instances of early ovarian insufficiency.
Doctors prescribe
hormone replacement therapy to treat menopausal symptoms like hot flashes and vaginal dryness. It’s available in pill, patch, spray, gel, cream, or ring form.
The association between hormone replacement therapy and cancer is complex and not completely understood.
Women who’ve had a hysterectomy to remove their uterus can use an estrogen-only hormone therapy. Those who still have a uterus should take estrogen plus progestin because the risk of uterine cancer is higher if they take estrogen alone.
Researchers have reported varying results around HRT and cancer:
- Women who took estrogen plus progestin had a slightly increased risk of breast cancer. According to one study, for every 10,000 women who took estrogen plus progestin for one year, there were 14 extra cases of breast cancer.
- Some research has shown that women without a uterus who took estrogen-only therapy had a lower risk of breast cancer than those who took combined HRT. However, other studies have found that estrogen alone may raise the risk of breast cancer if it’s used for a long time.
Research on the link between hormone therapy and other cancers isn’t straightforward either.
“Menopausal hormone therapy (MHT) is linked to a small increase in ovarian cancer risk, especially if used for more than 5 to 10 years. The overall risk is still low,” advises Pinkerton. “The risk may be higher for women who use estrogen alone after a hysterectomy compared to those who use both estrogen and progestin. The risk usually goes down after stopping hormone therapy.”
A range of factors can impact a woman’s choice to pursue MHT, and she should discuss them with her clinician. “When deciding about hormone therapy, it is important to weigh the benefits, like relief from symptoms, better quality of life, and prevention of bone loss, against the possible risks,” says Pinkerton. “This can help each woman make the best choice for her situation.”
The primary purpose of HRT is relief from menopausal symptoms.
The North American Menopause Society, the American Society for Reproductive Medicine, and the Endocrine Society issued a joint statement: “Most healthy, recently menopausal women can use hormone therapy for relief of their symptoms of hot flashes and vaginal dryness if they so choose.”
Talk to your doctor to weigh the potential benefits and risks and see if HRT is right for you. For many women, the newer low-dose options can offer relief that offsets the dangers.
Getting tests that screen for cancer is important for menopausal women. The American College of Obstetricians and Gynecologists makes the following recommendations for breast cancer:
- Average-risk women should undergo a screening mammogram starting at 40 years of age and no later than age 50.
- Average-risk women should have a screening mammogram every one or two years.
- Average-risk women should continue mammography screening until at least age 75.
The group adds that women and their clinicians should follow these screening guidelines as part of a “shared decision-making process.”
For
cervical cancer screening, Pap and
human papillomavirus (HPV) testing is recommended every three to five years starting at age 21 for those with average risk. If a woman has had three consecutive negative Pap smear tests within the past 10 years, testing can be discontinued after age 65.
A woman in the same age bracket and with a similar risk level can stop testing after two negative HPV tests or combined HPV tests and Pap smears at 60 and 65 years of age.
Women can also self-collect a cervical sample at home or in the clinic using a doctor-prescribed, U.S. Food and Drug Administration–approved sample collection kit. These are now acceptable for HPV testing as part of a cervical cancer screening. Repeated negative test results indicate that self-collection can occur every three years. However, a clinician should collect a sample every five years, as this is the preferred method.
“Pelvic exams and routine screening for ovarian cancer have limited ability to pick up ovarian cancer,” recommends Pinkerton. “However, if a woman has new persistent symptoms of bloating, pelvic or abdominal pain, abdominal distention, or a persistent change in feeling full after eating, or has a change in bladder or bowel symptoms, we recommend additional evaluation, including a pelvic ultrasound and a blood test for cancer antigen 125.”
Pinkerton advises that early detection can greatly improve survival rates, and to contact your doctor if you have new or ongoing symptoms that last more than a few weeks.
Some ways to help lower your risk of cancer:
- Avoid smoking. About 30 percent of all cancer deaths occur due to long-term tobacco use.
- Exercise. Physical activity may help to lower the risk of several cancers, including those of the breast and endometrium. Adults should get at least 150 minutes of moderate-intensity activity or 75 minutes of vigorous activity each week.
- Maintain a healthy weight. Being overweight is a risk factor for many different types of cancer.
- Limit alcohol. Drinking too much alcohol can increase your risk of breast cancer. Women should have no more than one drink a day.
- Eat healthy. A healthy diet has links to a lower risk of certain cancers. Try to eat at least two and a half cups of fruits and veggies a day.
- Practice safe sex. Use condoms when you have sexual intercourse, and limit the number of sexual partners you have. The more sexual partners you have in your lifetime, the more likely you are to contract a sexually transmitted infection, such as HPV.
The bottom line? Practice healthy habits in midlife to reduce your risk of disease.
“Menopause is a perfect time for women to assess their risk for cancer, get important screening tests like mammograms, colonoscopies, and Pap smears, and improve their health by exercising, eating healthy, and managing their weight to decrease their risk of cancer,” Pinkerton concludes.
Rachel Green
Rachel Davis
Derek Schulz
Sophia Martinez
Dr. Amara Okafor