Menopause After Cancer
My guest today is Vikram Talaulikar. We talk about Menopause after cancer, we cover the lifestyle and medical options.
Vickram is a certified ‘menopause specialist’ by the British Menopause Society. He has published widely in the area of reproductive medicine. His research focuses on events at the embryo-maternal interface in early pregnancy, ovarian response to stimulation in various endocrine conditions and menopause.
To learn more about Vickram, click HERE
thisisGO.ie is an online personalised resource for you and yours who have been impacted by a gynaecological cancer. Click HERE to find out more.
Transcript -Automatically Generated
Welcome to this next episode of Menopause Uprising. And this is one, oh blimey, I'm really excited for you to listen to this one. This is an aspect of menopause that I really wanted to start talking about more, and that's menopause after cancer. And I was thrilled to chat today to Mr. Vikram Thalekar from the UK, who's Absolute guru when it comes to menopause after cancer.
And I think you will, you see from the conversation that we have, we cover so much in terms of, you know, the lifestyle aspects that you can look at and also, you know, the medical options that are there. It's a really, I guess I feel it's. It offers a really exciting, hopeful view in terms of supporting yourself.
And, you know, Vikram is so passionate about women's health. Not only is he an expert in menopause, but he's also an expert in relation to fertility and many other aspects of women's health. So I think you will see the passion coming across quite clearly. I hope you enjoy the session. So Vikram, one of the many subpassions that you have within women's health and menopause space is looking after women who experience menopause after cancer.
It's an aspect of menopause that I actually always say natural, spontaneous menopause is a privilege because I find the earlier forms of menopause from POI to, you know, um, surgical induced menopause, It's just so much more challenging. Could you just, for our listeners, could you just explain how that happens in relation to the different scenarios that can result in a woman going into menopause, maybe earlier than she should?
Yes, um, and you're very right, particularly after cancer, from a cancer perspective, and you're very right when you said that everyone's menopause experience is different, especially for women who have to go through cancer, cancer treatment, and then have premature early or menopause simply due to cancer treatment.
The experience can often be more severe in terms of the symptoms experienced, as well as the therapeutic or treatment options tend to be limited. Now, why does it happen after cancer or cancer treatment? And there are various reasons why someone may go through menopause simply because of having cancer and having treatment for it.
And we're largely talking here about gynecological cancers or breast cancer, because that's usually where most of the menopause related situations exist, but also about few other cancers where chemotherapy or radiotherapy may be needed. Again, pushing a woman into menopause. So what are the treatments that can lead to menopause after cancer?
Surgery. So if someone has had to have their ovaries removed as part of surgery for benign or malignant tumors that affect ovary or the womb or the fallopian tube, any surgical removal of ovaries will immediately cause acute surgical menopause. And it could be premature below 40 or early between 41 to 45 or even after 50.
Then you've got chemotherapy. Chemotherapy is a very strong medication. It basically damages any dividing active cells and of course the ovarian follicles or eggs are active cells. So any chemotherapy will cause damage to ovaries. And for women who have got a small store of eggs, it will push them into having acute menopause.
Then you've got radiotherapy. So some women may need radiotherapy as part of the treatment and especially if it's in the area in the pelvic region, then the radiotherapy will have a direct impact on ovaries. and push a woman into menopause. And then, of course, there are some other treatments. For example, the ones that we give as anti estrogens, uh, after, say, breast cancer treatment or any hormone sensitive cancers, or there are some medications even, uh, which can induce menopause like the GnRH agonist.
These can mimic menopause or, again, cause menopausal symptoms. So, all these will be various ways. A woman may end up experiencing menopausal symptoms or actual menopause after cancer treatments. And in, am I right in saying, I, you know, I know many women will say, and I've actually only out of talking with thousands of women, Vikram, I've only met one who actually, um, had cancer induced menopause and she actually didn't have any symptoms, but there was only one woman I met out of so many, is it, is it, would you say that the majority of women, the symptoms tend to be more severe from, for as a result of menopause?
Certainly. So for the large proportion of women who have menopause as a result of cancer, symptoms tend to be more acute, sudden onset, because often it follows a month of chemotherapy or an operation, and within 24 to 48 hours, you've lost all your hormones, and that's quite a big shock for the system. Um, but they tend to be more severe.
So if you look at the severity of symptoms, maybe because it happens in such a short span of time, the body hasn't got time to react. So often the flushes, the sweats, the sleep issue, the profound mood changes, and they tend to present much more in a severe way for many, and they tend to be persistent. So With natural menopause when you have the gradual decline in hormones, maybe you've got a little bit more time, uh, and you tend to adjust a little bit after a few years.
But here it seems like because it may be because these patients may be young and, and it's acute form of menopause, the symptoms tend to be severe for a longer period of time. So persistent, that's what is often seen in the clinics. So if you had, let's say, for example, if you had a young, young, young woman, maybe say in her late thirties, who, um, went into menopause as a result, when would you say, you know, could she maybe expect those symptoms to start to abate?
It's a difficult one to answer because all of us are so different and often when I, when I'm in the clinic and I'm, I'm kind of. Talking to the trainees who are in the clinic, when we see each woman, uh, we're, we're sometimes surprised you have somebody who's just gone through cancer treatment, has had quite a bit of chemotherapy.
And then six months down the line, you often see them in the hormone clinic and, and they have got adjusted. They're doing a lot of non hormonal lifestyle things and they feel that they are at a position where after those acute horrible symptoms soon after surgery or chemotherapy, they seem to be stabilizing.
The symptoms are better than before and they may not actually take up the option of hormone replacement if we offer it to them at that point. Okay. Um, and over one or two years, you might find that they do actually get adjusted to symptom where they may say, I'm fine, I will carry on unless there are more symptoms, I'm okay.
Okay. But then you have the flip side of it is somebody who has been, had treatment, completed treatment, say two, three, four years ago, and still having profound hot flashes and night sweat even five, 10 years down the line, to the extent that they try to HRT reduced little bit of dose, but the body often comes back with vengeance, lots of symptoms, so they have to go back to it.
So there's a wide range and it's difficult to give a time point, but as a general answer I would say the first three to four years are the most difficult. the most symptoms, and then somehow you tend to have a slightly better symptom resolution after that. And when you mentioned that, you know, some of your patients have had good results from, say, lifestyle changes that they've done, can you give us what would be examples of that that you have found have been very supportive for women?
Well, very simple things matter. So, a number of times women may not want to take HRT, for example, hormone replacement therapy, which is usually a first line medication for young women going through menopause. But there may be some who may have inhibitions, may not want to use hormones, they may have had that type of cancer where we don't have a lot of data.
to reassure them that the long term safety of hormones we can guarantee. In that case, they often combine a few things. For example, they may do lifestyle changes, um, they alter their work patterns, often take it easy on their work if they can, often a flexible working environment. A lot of women come in and say, I used to do that much before, which was a packed week.
But now if I split my work and I try to do different times on the days, I find I can manage my symptoms. I tend to work more in the evenings and I have less flushes than doing them in the morning, for example. Very interesting. That's very interesting. Yeah, a lot of women change their night shift pattern.
So those who are doing night shift often say, actually, I find that I can't do so many nights now because my sleep is not great on the other side of the day. And so I might actually do some more of day work now, less of night work. Others find the night work is better because they anyway Find that it's the active time and they tend to find that they're tired.
They sleep better during the day. So people alter their work patterns based on when their symptoms are and what their symptoms are. And I think that's that's really interesting, isn't it? Because it ties into the fact, you know, there's a lot of work being done. I know in the UK Well around employers and workplaces being supportive of, you know, women as they transition through this chapter.
And I think, yeah, I think that's a great, um, kind of example of where you can have flexibility around supporting. So Vikram, as we know, like every single woman's going to have a different experience and so, you know, it's different things we'll, we'll support. And would you find, would you find that, um, If we look at the symptoms of menopause, and you mentioned hot flushes, night sweats, the sleep issues, the anxiety, are they the ones that you would say are tend to be the most challenging for women who go through menopause after cancer?
Would, would, would a vaginal atrophy come in there as well, or is there other symptoms? Yes, so the biggest one that you often get acutely soon after chemo, soon after radiotherapy or surgery are the hot flushes, the sweats, the difficulty sleeping, and of course that makes you tired throughout the day. And finally, the mood fluctuation, the profound drop in mood or the anxiety palpitations that have gone up.
Those are the, those are the biggest ones. Yes, vaginal atrophy is a problem and it's often underdiagnosed, undertreated, but you find that how happens a little bit later. So you would have had a bit of time having had no estrogen in your body and the changes take a little bit of time for the vagina to have dryness, the soreness, the irritation.
So usually around one or two years, unless you've been proactive and treated it before, you tend to find that it's that particular time around two years after the treatment where women may then say, actually I've been. trying to persist with this and see what happens, but it's got to a point where I can't do, can't sit properly, I can't have intercourse.
That's usually the time that you have the vaginal problems surfacing. So that's a great kind of a proactive step that someone can take in terms of You know, using a good vaginal moisturizer, you know, locally estrogen, if they can, etc. Very, very beneficial. And in terms of other lifestyle, you know, what other lifestyle aspects would you see come into play?
I do want to talk about medication in a minute, but just to close off that aspect of it. So, so as all of us know, and we often post on social media, or we often emphasize, it's about having the balance. So healthy diet. Uh, because an unhealthy diet will not help with symptoms as well as your long term health.
So anything that you can fit into your lifestyle, eating small portions throughout the day, making sure it's not too fatty, no, not too sugary diets, uh, having some plant estrogen usually works. Now there's not a lot of evidence for that. So when you talk about soya or tofu or phytoestrogens in foods, the scientific evidence is very little.
Because these phytoestrogens may be 1000 effect of actually estrogen in the HRT. So it's a very, very weak estrogenic compound. But nevertheless, a lot of women who don't want to take HRT or can't take it, increase their phytoestrogen intake and often report that there is some, uh, effect on their symptoms.
They feel their symptoms are a little bit less. So if you can increase your phytoestrogen, that would be something to add to a already healthy diet that you have. And you know, we've heard many times in the media about how soy might be an ingredient you don't want to have in your diet if you have had cancer.
Is that still, is that still the feeling or what would you say? No, so phytoestrogens are so weak and because they're part of your food, I certainly don't tend to tell my patients to avoid soy or phytoestrogen. What you, what you often don't have to, what you have to avoid. Or you should be careful about using other herbal products.
So often these two are used interchangeably. Herbs or herbal products where we don't have enough data about their use in women who have had breast cancer or hormone sensitive cancer, we can't recommend. We don't know what the effects are in 5 or 10 years. Food plant estrogen is so weak and it's digested and it's metabolized that that itself contributing to recurrence or cancer occurrence is, is probably not biologically realistic.
So you can certainly have a dietary plant estrogen. And of course, a lot of those phytoestrogens come with great additional nutrients and minerals, you know, as well, which is it, which is a great benefit. And what about, what about movement, Vikram? What are your thoughts on kind of exercise and movement?
You're probably much better at advising that Catherine than me, but again, the same advice is movement is life. And so having that regular physical activity, anything that you enjoy, you can fit in your busy lifestyle. That is the key. If you go to the gym for one week and lose 10, 000 calories and the next week, you're not going there.
All of us will be off that, but that's not going to help. So anything you can sustain over a year, two years, five years, but regularly, and there are a lot of women who actually have done fantastic exercise, physical activity. And have told me they don't want to do anything else. Exercise keeps their symptoms away.
Gives them that satisfaction of having done something for themselves. And they find that actually helps them a lot during this transition. Whether it's mood, whether it's physical symptom, it gives them that positive aspect in their life. Which often is, is valuable when you're going through this difficult journey after the cancer treatment.
Isn't that lovely? Because, you know, that's so accessible to everyone. You can walk, you go out the door and go for a walk or you can deliver that movement is I, that's really, that's lovely to hear that. I think that's quite refreshing in terms of, you know, look, we know how beneficial movement of all types is, but I think particularly when you've come through such a challenging journey here already.
You know, to get to, to get to this stage, just on the movement, Bikram, is there anything, you know, obviously as we get older, we know that our bones come under more pressure. Is there anything that women who go into early menopause like this should be extra aware of when it comes to their bone health? Yes.
So if you've had premature or early menopause, or for example, you've had cancers where you've had to have treatment which could affect bone health. For example, if you take aromatase inhibitors after you've had cancer treatment for breast, all those situations, you are going to be at risk of osteopenia, osteoporosis, and lack of bone density.
So standard advice. Uh, before you need to consider, say, bone medications or hormone replacement, the simple lifestyle measure would be first, movement, exercise. And for bones, we say weight bearing exercise. Anything that goes against the gravity, uh, brisk walking, running, Jogging, jumping, uh, swimming doesn't help, but anything that's sort of anti gravity would help.
Vitamin D and calcium. Vitamin D is supplement, especially in cold winter countries. In Ireland. Absolutely. Absolutely. And calcium, we, we often now say through food, if you can manage to get it through your diet, it's much better, simply because, although it's controversial, there were some studies linking excess calcium to heart disease.
And so we often say, if your diet is rich in calcium, the excess calcium may not be beneficial. So don't take it. And I think that's a, that's a big conversation around the calcium, but I like, I know here, actually, like if I went through my food in a day, I get a lot of calcium through. You know, uh, your yogurt, your, your yogurt, your different foods that are fortified, et cetera.
So I think it's great if we can always do food first, but I know for everybody, that's not always, not, not always manageable. Um, and would you advise, would you advise someone getting a DEXA scan or I'm not sure what your process is in the UK here in Ireland, you generally only get a DEXA scan, you know, really.
You know, it's maybe, maybe when you hit 50, but you have to push for it yourself, you know. Okay, so certainly anybody with menopause below 45 should have a baseline DEXA scan. That's because you've had stopping of your hormones earlier than average. And so you would have a baseline DEXA just as part of your routine care.
And then how often you repeat that will depend on, are there any other risk factors? How severe is the osteopenia or are your bones normal now? Are you on HRT, off HRT, or any other bone intervention? So it could be repeated in two years for those with significant bone loss, or it may be five years later if it's good bones, but certainly anybody below 45.
Or, uh, with history, family history of any osteoporosis or pneumia has to have a baseline bone scan as part of their care right when they are finishing their cancer treatment and then every few years. Great. Okay. Yeah, that's great. Great advice. And so we've talked a lot about kind of the lifestyle measures that, um, women can find supportive.
Now let's just see if we take some of the big symptoms. So, you know, the one, I guess I would hear about the most would be the hot flushes and night sweats, and this can be women who are getting 40, 50 a day, like really, really intense. What are their options? Let's say where HRT isn't an option for them.
What are the other options that they can look at? There are plenty of them. So if you're talking about women who cannot take HRT, Then, of course, the first thing we talked about is optimizing lifestyle. So diet, exercise, doing some form of regular physical activity. And then, of course, small things, for example, adjusting your work, access to cool water at work, clothing, what kind of clothing you wear, which gives you the less flushes or sweat.
All of those are small things in day to day life. In terms of the therapies, you've got the non pharmaceutical therapies, and these will be mainly, we heard recently about the cognitive behavioral therapy. And this has actually been most well studied in women with breast cancer, uh, who had treatment for breast cancer.
And that's where there's maximum evidence that CBT does help hot flushes, does help night sweats, and the sleep issues. As well as the mood, so it could be one therapy, which doesn't involve taking a medication and some women like that. I've had breast cancer, uh, treat, uh, treatment, uh, post cancer survivors who simply have used CBT, a long style lifestyle measures and have done well.
Great. Okay. Then, of course, you have pharmaceutical treatments. Pharmaceutical treatments would be often either antidepressants like melaleufexine or SSRIs or SNRIs. You've got gabapentin, pregabalin, clonidine, and I won't go too much into, say, pharmaceutical details here. Mm hmm. These have benefits for flushes, mood, sleep, sweats.
They tend to improve your symptoms. But they have some side effects like they may cause you dry mouth or constipation. Uh, sometimes they may cause drop in libido. Uh, and for those reasons, it's always a balance of benefits versus risk. So if the symptoms are severe, you might say actually the drug is beneficial.
The symptoms are mild. Maybe you don't want to have those additional, uh, side effects. So you kind of balance the two, which one is right for that individual person. And then of course you have some alternative therapies. Like for example, we do have tie ups with the Royal London Hospital for Integrated Medicine, which used to be called as the Homeopathic Med, uh, Hospital in the past.
And they offer a combination of certain herbal treatments, uh, which they have experience with and are considered safe. Homeopathy, uh, acupuncture, acupressure, uh, and also some, uh, talking therapies, uh, and something like CBT and counseling. So you can have holistic or alternative therapies. It's not for everyone and not everyone may choose to have them, but a significant proportion of women find that helps as well.
Grace. And I think that's where it kind of, it's, it's the individual nature of the experience is so important, Vikram, isn't it? Because I guess I always say that, you know, it's so important that we have respect for each per each woman's experience because it's just going to be so different. And that means what your management options are.
Are going to be different and different as well. And what about, um, let's say, for example, if you have a patient who's on tamoxifen, um, what, you know, is there any specifics there that you would say you've experienced have been quite supportive, you know, particularly again for, I'd say the sleep, the hot flushes, night sweats.
In our own clinical practice, we find CBT and the vaccine are the two best ones if you're really suffering with symptoms. A lot of women feel hesitant to take venlafaxine because it's classed as antidepressant. They don't want to go on it because they fear they will be on it for a long period of time.
They may get dependent on it. But actually, in real practice, I find that women for the first five years or 10 years of having completed their treatment on tamoxifen or adjuvant therapies do tend to do well on venlafaxine. They use it for five, 10 years, and then they're able to come off when they don't need it.
Similarly, side by side, they will be doing CBT. They'll be trying to lifestyle measure. So altogether, you see through the worst symptoms at that point in time. And then by five or 10 years down the treatment, you often find you don't need the medical therapy. So you just carry on with the non medical ones.
Okay. Yeah. Yeah. And just when, um, uh, you're mentioning there about antidepressants, I find this now, and I don't know if your experience is the same, I find that there is nearly an, like, an anti antidepressants kind of movement there. And it's, what I always kind of see is like, All medications have a role to play and like we know that HRT is the first medical port port of call for someone who can't seek it for menopause symptoms.
But in some situations, um, you know, given person's medical history, et cetera, antidepressants can be extremely supportive. Absolutely. I can almost see two groups of women. Women whose lives have been transformed by HRT. Absolutely. It works wonderfully well. But I can also see my other group, my other clinic patients, where they can't take HRT, do not wish to take HRT, and antidepressants have worked wonderfully well.
Their mood has stabilized, their symptoms have decreased, and they're able to carry on with a good quality of life. As you rightly said, everyone is different and every medicine has a role. I was talking to, I was talking to a husband very earlier this year. It was at my book launch back in February, March.
And he came up to get a copy of my book for his wife. And I ended up chatting to him and he told me that his wife was on antidepressants. But actually she was afraid to tell her friends. That she was on antidepressants, because I guess, look over here, it's all about HRT, which I think is brilliant. We have the awareness, but I think we have to just keep that conversation very balanced and, you know, and respectful, but I remember kind of feeling, Oh my God, that's just, that's mad, you know?
Um, so I think, look, yeah, I think that's just really important for people to understand that, you know, antidepressants have a very supportive role to play as well, you know, in, in. in scenarios. And, um, would you, would you find in relation to another big symptom now that I will hear a lot about and particularly in the workplace will be brain fog.
And is that one that you would see that, you know, is one of the kind of the top ones? Yes, brain fog is peculiar because brain fogging can happen for many reasons. It's not classically the lack of oestrogen. Um, we have certainly found that it's a symptom of menopause as the oestrogen levels will decline.
perhaps a little bit of dropping testosterone, both contribute to the brain fogging. Uh, the difficulty is often dissecting that bit out from all the other influences that are happening, especially in cancer patients, because they've gone through this huge difficult journey. I mean, they're fatigued because they may be on multiple medications.
Uh, the medicines they take often cause dizziness, brain fogginess. In addition, you're probably having some more chemo, uh, then of course the lifestyle has changed, uh, and the life circumstances have changed, uh, you're kind of balancing your work family alongside your cancer treatment. And all of that will often contribute to some of the cognitive symptoms in addition to the lack of estrogen.
So often, of course, yes, we do recognize that this could be contributed to by the lack of estrogen and we offer the same sort of treatment, including hormone replacement. And of course, other forms, for example, CBT and trying to understand why they're having these symptoms. But it's one symptom where I think, One has to give enough time to see how the symptom develops, how much of it is hormone contributed, but also work on other aspects, the lifestyle, the fatigue, and the medications, which may also be causing a bit of brain fogging.
So both need to rest. Again, I think that is, that is one of the challenges with brain fog, I guess, you know, and if you think, you know, particularly for women who have Come gone through a cancer journey. I mean, that's a lot going on in your life. That's right. I think with brain fog, it's always exasperated by life, right?
By just the everyday struggles. And then you put a major health and life events like cancer on top of that. And certainly it's very hard to see, you know, it's, it's multifactorial. Isn't it? Of, of what, what you're experiencing. Um, I guess it's, it's, it's the one symptom that, you know, we'd see a lot in relation to, you know, in the workplace, as I, as I said, you know, women would really find that, um, find that, find that a struggle, one of the, kind of the key areas that leads into.
I, I would feel leads into heightened brain fog is sleep. So with, with patients, Bikram, who are struggling with sleep, is it CBT I that you would look at, or would you have anything different to what we've already talked about? No, I think we've covered most of it. So again, What you eat when you eat a good physical activity during the day, uh, making sure you have a good sleep hygiene, not taking screens to bed, for example, uh, also making sure which is which is sometimes we all are guilty of, um, but again, making sure that if you need help accessing CBT.
There are some sleep clinics now, which have sprung up across the country. Uh, there are very few, uh, and the referral can take a long time, but I've had some women who have actually gone to see sleep clinics and considered some medications, which we would, for example, not routinely offer in, in the, in the HRT clinic, for example, things like melatonin or things like other, uh, uh, sleep medication, uh, which needs to be carefully considered about its long term effects.
But some women have got to a point where they just couldn't function, and they tried all the sleep hygiene measures and the CBT and a few other measures. Yes, there is medical help, and it's best to get it through a specialized, a specialist sleep clinic. But for majority, The ones that we talked about will work.
And you mentioned just melatonin there. Is there, is there, um, Is there any evidence behind that? Or is there kind of a risk of taking melatonin for too long? That it could have, um, you know, more risks than benefits? Yeah, so certainly I don't recommend melatonin. Uh, because I think the studies, particularly in the setting of menopausal sleep deprivation, haven't happened.
Melatonin is well studied, well sort of, uh, established when you are trying to take away the sort of travel, uh, related, uh, sleep issues. That's usually where it's best used. Uh, we, we had, uh, a sort of talk on this issue even at the recent BMS conference, and people thought that melatonin doesn't have enough evidence really to be used as a Uh, therapy or as a treatment for sleep issues, however, um, again, it's individualization.
You might have an individual who's tried everything under the sun and is really exhausted because they cannot have even a small, good quality, small duration sleep. And for them, melatonin may make a difference. And so there will be some women who might say, okay, the evidence isn't great and the longterm effects haven't been well studied, but I may go for it because right now I need that little bit of sleep.
And if it can get me my quality of life, I'll see what happens in the next few years. And that's why I said it's good to be under a specialist clinic or a doctor who would probably monitor you and how you get on with it. If you're going to use it. Yeah. I think it's got like, you know, if we, if we don't get a good night's sleep, I mean, we all know what that feels like, you know, be it illness, young children, Yeah, it, it just is.
So it just, I mean, it just, your setting, your D is just starting off laden with that exhaustion and, you know, you're compounding that with the tiredness and exhaustion that can come with menopause as well, which can be really, really challenging, um, um, for, for, for many, for many women in relation to, you know, let's see, A woman is about to go and have surgery and what we, what I would find here is there's little conversation before the surgery.
Obviously it's all, you know, in relation to, um, cancer and just keeping a woman safe. But what would you say in terms of, or any advice that you would give someone who is going for surgery, just that they can be prepared on the other side? It's, it's very good. You brought up this point, Catherine. This is one area where health professionals.
have let themselves and the patients down. Certainly, you keep seeing women who've gone through life changing surgeries, removal of ovaries, or cancer treatments such as chemoradiotherapy, without having any preparation about the possibility of early premature or surgical medical menopause. And it can really hit like a shock when it happens.
You're already out of your treatment, you've had your surgery, you've already had your chemo or radiotherapy round, and suddenly you start feeling terrible with all the hypoestrogenic symptoms. The preparation is the key. So anybody who's going to have a surgical menopause or a medical menopause, it's really important to put the plan of what will happen to your hormones after this intervention, much before that intervention happens.
So for healthcare professionals, I always say you cannot, unless you are absolutely have no time, for example, an aggressive cancer, you have to do it in a week or two. You may have very limited time. You have to save patient's life, as you said. But in most circumstances, you would have enough time, a few weeks or months, where you can certainly sit with your patient, even if you don't have the expertise.
Involve a healthcare professional who would be talking about hormones alongside your plan for surgery or chemotherapy, so that they know that this is what is going to happen to their hormones after the intervention. And what can they do? The lifestyle, the non hormonal, and even HRT. For many surgeries or post chemotherapy situations, you can start HRT very early now.
So having that plan and letting the patient have a choice, that if you don't feel well, you're not able to cope with the symptom, you have X, Y, Z, we can start even when you are on the ward, even when you've gone home, and even when you are having some further care in the community. So that preoperative or preoperative planning is, does not happen right now for majority, but it's something that should be mandatory going forward for patients.
My advice is yes, you have a lot to take in. If you've been diagnosed with cancer, the last thing sometimes you're thinking about is hormones or fertility. But remember that it's a big decision. And you will probably come to, uh, have the effects or think about it after you've recovered from your cancer treatment.
So if possible, try to go to established or regulated websites where there is plenty of information. Whether it's gynecological cancer, there's very good information now on some websites, whether it's premature menopause, British Menopause Society, Daisy Network, uh, gynecological cancer societies, plenty of patient information.
You will at least get to know what you're going to go through, what the effects would be. And you could ask your surgeon or your oncologist those questions where they can make a plan with your hormone specialist what to do after you've gone through those interventions. Yeah. Yeah. So beneficial. Cause you often hear, I often hear from women, it was like, see oncology nurses who are telling me, you know, use X, Y, or Z or, you know, whatever, but they weren't aware.
So I think the key part of it, um, is that awareness. And I put in some, some links in the show notes, like the women's health concern. I find this a fantastic site and, um, obviously follow it, following, um, yourself as well. It's hugely beneficial. And I think, and I know we've only, we've. We've only touched on it, but you know, I would, I would talk to many women and they, which is, they're very prepared and they would say, I've talked to my, uh, my surgeon, I'm coming into hospital.
I'm going to have a patch on me. I'm all sorts of, but I guess that's for the, that's for who can take, um, HRT. So, you know, I think the importance is covering what the options are given your different form of cancer. So that sort of an experience is what we want with every woman that the person you describe that is exactly knows what's going to happen, knows what their options are, they're prepared for it, and have had a chat with their health team beforehand.
That, in my opinion. World would be an ideal going forward. Oh, totally. I'm 100 percent with you because you're down eliminating suffering. That's what it's all about, isn't it? It's like we shouldn't suffer. And it's trying to just have the awareness and the empowerment there that you're actually, you know, You know, that you feel empowered, that you can advocate for yourself.
And unfortunately, that's something that I feel we still have a lot of work to do on. We're making progress, but I often think that, you know, sometimes women, they just maybe don't feel strong enough or don't feel empowered enough to maybe push that conversation. And, and I totally understand that can be so challenging when you're already faced with cancer, you know, um, we've covered so much and, and I knew this, was very excited to talk to you today because I love, um, following you.
And obviously we've, um, great friends, um, in common, but any last, Um, piece of advice that you would give to anybody who is maybe just in the process of this journey or the other side, or it's coming ahead of them. Absolutely. So I think we talked about planning preoperatively. So if you've been diagnosed with cancer or pre cancer condition, You're going to need some form of intervention, surgery or medical therapy.
Try and visit websites related to that particular condition. There are some very good websites and, and Catherine, uh, you can give some resources, uh, to the, to the listeners, to the audience. And, and of course, those websites will guide you then to further signpost you to better, uh, particular condition related website where you can find information.
Lot of cancers now. Uh, after treatment of these cancers, we can offer HRT. So we've talked about non HRT, lifestyle intervention, hormone replacement for those women where it's safe to have it after certain forms of cancer. Can, of course, drop symptoms, improve quality of life, protect the long term heart and the bone health.
So that should be one of the options for women who have premature early menopause or those who are at particularly risk of these issues after their cancer treatment. And the notion before was that after cancer, no one should have HRT. That's changed. So with almost majority of cancers, you can safely have HRT now.
Some hormone dependent cancers, it's an individualized decision, or you may not be able to have it. HRT. But that's a discussion you have with your health care provider team and you make an individualized decision with them. But otherwise, overall, I think, as you rightly suggested, we're going in a positive way.
There is more awareness, more availability. We have to keep that trend going so that almost every woman in future who is diagnosed with cancer, We'll have all the resources and support she gets to navigate the menopause, uh, successfully after that. Yeah. Yeah. No, I think that's, that's, that's definitely where we want to get to, isn't it?
And Vikram, thanks so much for chatting to us today. And I'll put loads of details in the show notes, um, and where people can follow, follow you as well. Um, thank you for the amazing work that you are doing because I, I love to see the research and the impact. information that you're that you're sharing, and I know you're such a passionate, passionate advocate, not just of menopause, but of women's health.
So thank you for everything that you're doing, and we will chat again soon. It's mutual, Catherine. Thank you so much for having on the show and all that you do in this space. Thank you. Thank you. Look at the show notes because I am adding in some resources and I would encourage you to also look at the Irish website, this is go.ie, which offers support to women who've experienced gynecological cancers. For more details and information in relation to menopause, please do check out my book All You Need to Know About Menopause, which is available on Amazon and also in your local bookstore. See you next time. Thank you.
