Menopause and myeloma 

Menopause naturally occurs with age, but experiencing the menopause whilst also living with myeloma can bring additional physical and emotional challenges. Some myeloma treatments including high-dose melphalan used before a stem-cell transplant can also trigger early menopause.  

In this month’s blog, we answer some of the questions you ask our Myeloma Infoline team about myeloma and the menopause. 

What symptoms does menopause cause? 

Menopause is reached when you do not have a menstrual period for 12 consecutive months. It usually affects women aged between 45 and 55 but can happen earlier. It affects anyone who has periods. 

Perimenopause is the lead-up to menopause. During this time, periods typically become more irregular. This can last for several years.  

Symptoms vary from person to person but may include: 

• Hot flushes and night sweats. 

• Difficulty sleeping and fatigue. 

• Mood swings, increased anxiety or depression. 

• Poor memory and brain fog. 

• Reduced sex drive. 

• Vaginal dryness, soreness or discomfort. 

• Joint or muscle pain. 

• Headaches or migraines. 

• Digestive issues. 

• Recurring urinary tract infections (UTIs). 

Living with these symptoms can heighten the emotional impact and physical side effects of myeloma and its treatments. 

Your healthcare team can help you explore ways to manage symptoms, discuss whether hormone replacement therapy (HRT) may be suitable for you, signpost you to a specialist or menopause clinic and consider whether any changes to your supportive care or treatment plan could help. Our Myeloma Information Specialists can also offer support – get in touch on 0800 980 3332 (UK) or use our Ask the Nurse email service. 

You can find more information about managing the emotional impact of living with myeloma in our Psychological wellbeing and myeloma Digital Infoday Session. If you are looking for additional menopause specific support, organisations such as Macmillan Cancer Support and Menopause and cancer provide information and resources that you may find helpful. The British Menopause Society (BMS) has a searchable register of menopause specialists. Women’s Health Concern is the patient arm of the BMS and has a lot of information and resources on their website, including a menopause wellness hub.  

Will my treatment cause early menopause? 

Some treatments for myeloma can cause early menopause in people who have not yet entered the menopause. You may also hear this referred to as treatment-induced or medically-induced menopause.  

For example, high doses of melphalan – a chemotherapy drug used in high-dose therapy and autologous stem cell transplant (HDT-SCT) – can trigger early menopause. Symptoms may sometimes be more intense if the menopause starts suddenly because of cancer treatment. The thought of experiencing menopause earlier than expected can feel overwhelming and it is natural to have questions or concerns about the impact it may have on different aspects of your life. 

For people who have not yet started or completed their families, this can bring additional concerns about fertility. Menopause means that natural conception is no longer possible. If you are worried about the loss of fertility, speak to your healthcare team as soon as possible to discuss possible options to preserve your fertility.  

You can read more about fertility in Section 5 of our Infopack for living well with myeloma, our Ask the Nurse blog on myeloma and fertility or watch our video about Issues for younger myeloma patients.  

What support and treatments are available for menopause? 

There are a range of ways to manage menopause symptoms and what works best will vary from person to person. Some people find symptoms improve over time or choose to manage them through lifestyle changes alone, while others benefit from additional treatments and support.  

Lifestyle measures such as regular physical activity, maintaining a healthy weight, reducing alcohol intake and prioritising good sleep habits may help improve some symptoms and they also support overall wellbeing while living with myeloma. 

Hormone replacement therapy (HRT) may be suitable for some people and can help reduce the symptoms of menopause. The NHS website states that the risks of HRT are small and are usually outweighed by the benefits of reducing symptoms, for example hot flushes and mood swings.  

HRT may also help protect bone health. Menopause can affect bone strength because falling oestrogen levels increase the rate of bone loss, increasing the risk of osteoporosis, a condition that causes bones to become weak and fragile. As myeloma can also affect the bones, your healthcare team can advise on monitoring bone health and treatments that may help protect your bones.  

If HRT is not suitable for you, or you decide it is not the right option for you, your healthcare team may be able to discuss other options to help manage symptoms. They can also help ensure that menopause symptoms are considered alongside your myeloma treatment and supportive care. 

Are there risks for myeloma patients taking menopause treatment?  

The potential risks associated with HRT depend on a range of factors including the type of HRT, how long it is taken for, a person’s general health and age.  

HRT can increase the risk of blood clots when taken in tablet form. Myeloma can also increase the risk of blood clots, as can certain myeloma treatments. For this reason, healthcare professionals may consider other forms of HRT such as patches, sprays or gels, which do not increase the risk of blood clots. Our Infopack for living well with myeloma contains some information on menopause and HRT (page 73). 

How can I tell if my symptoms are from myeloma or menopause? 

Symptoms such as fatigue, poor concentration, sleep problems and mood changes can be caused by menopause, myeloma or its treatments. Because there is significant overlap, it can be difficult to determine the cause so it is important to discuss all symptoms with your healthcare team and let them know about any new, changing or worsening symptoms.  

This overlap can sometimes make it difficult to identify what is causing a symptom.  It is also one reason why early myeloma symptoms are often mistaken for other conditions such as general ageing or menopause. Our Myeloma Symptom Translator lists examples of symptoms and can help conversations with GPs. 

If you have any further questions or need support, contact us through the Myeloma UK Infoline at 0800 980 3332 (UK) or use our Ask the Nurse email service