Bowel cancer and menopause

Understanding your options if you’ve had bowel cancer

Bowel cancer is the third most common cancer in females in the UK
Women may miss signs of bowel cancer while going through the menopause
Cancer treatment can cause a surgical menopause. Discover how to treat symptoms

If you’ve had bowel cancer you may be wondering how menopause affects you. Or you may have been through menopause before your cancer diagnosis, so it can come as a shock to experience further menopausal symptoms after your cancer treatment. Here, we take a deeper look at bowel cancer and menopause, and the treatment options open to you.

Who does bowel cancer affect?

Women are less likely to get bowel cancer than men, but it is still the third most common cancer in females in the UK [1]. Approximately one in 19 women (5%) will be diagnosed with bowel cancer in their lifetime and although it can affect people of any age, 94% of bowel cancer is diagnosed in those aged over 50 [2].

Symptoms may include: changes to your bowel habits that last more than three weeks, blood in your poo, which may look red or black, rectal bleeding, abdominal cramps, bloating, unexplained weight loss, fatigue and anaemia.

In the early stages of bowel cancer you may have few symptoms or none at all, and equally, some of these symptoms can be present in other conditions, such as IBS.

REALTED: IBS and the menopause: what’s the link?

It’s also possible for women to mistake signs of bowel cancer when they are going through the menopause – fatigue and bloating can occur during the menopause, for example. If you have endometriosis, you may attribute abdominal cramping to that condition. However, one review paper found that women are more likely to experience an aggressive form of colon cancer [3].

How will bowel cancer treatment affect me?

Bowel cancer treatment will depend on the size of the cancer, its location, if it has spread, and your [PW1] age and general health, and will be personalised to you. You may require surgery to remove cancer from the bowel, part of your bowel may need to be removed and/or you may need chemotherapy, immunotherapy or radiotherapy.

Treatment for bowel cancer can lead to earlier menopause, known as a surgical menopause.

RELATED: surgical menopause

I’ve been treated for bowel cancer, now what?

For some women, a surgical menopause can be hard-hitting owing to the sudden, dramatic loss of oestrogen, as well as progesterone and testosterone. You have oestrogen receptors all over your body, which is why the loss of oestrogen can cause a myriad of symptoms. Hot flushes and night sweats are common, but you may also notice joint and muscle aches, vaginal dryness, mood changes, fatigue and poor sleep, brain fog and urinary symptoms such as recurrent UTIs.

Some women may not experience symptoms of menopause, or not be too troubled by them, but you may still want to consider the long-term effect on your health of having low hormones. HRT lowers your future risk of developing heart disease, osteoporosis, type 2 diabetes and dementia.

REALTED: menopause and cancer booklet

Can I take HRT?

HRT is the first-line treatment for menopausal symptoms and for most women, the benefits outweigh the risks. Your healthcare provider will help you to make a personalised choice.

Interestingly, a significant (20 per cent) lower future risk of developing bowel cancer has been shown in women who take some types of HRT [4]. It’s not known exactly how HRT affects the bowel cancer risk, but it’s thought that hormones may play a role in decreasing levels of insulin-like growth factors that are associated with some cancers.

If you have your ovaries removed but still have a womb and would like to take HRT, you’ll need to take both oestrogen and progesterone. For those aged under 45 who have a surgical menopause, you may need a higher dose of oestrogen than someone who has gone through menopause naturally, at an older age. If you have your womb removed, you don’t usually need progesterone – you can have oestrogen alone. In most instances, you will be offered transdermal oestrogen, which has no risk of clot.

If you can’t or don’t want to take HRT, you may still be able to take vaginal oestrogen. Many women who go through the menopause will experience genitourinary symptoms such as vaginal dryness (which can affect 60 per cent of postmenopausal women), pain from sexual intercourse or recurrent UTIs [5]. Vaginal oestrogen, which works locally only, can provide relief [PW2] and prevent discomfort.

How else can I manage my menopause symptoms?

If you are experiencing vasomotor symptoms (flushes and night sweats) you may be offered antidepressants or other prescription drugs such as gabapentin, pregabalin, clonidine or oxybutynin to relieve them. Cognitive behavioural therapy (CBT) and hypnotherapy can help anxiety-related symptoms.

It is worth remembering that herbal medicines, such as black cohosh, red clover, ginkgo biloba and St John’s wort, and bio-identical hormones are not regulated.

Lifestyle interventions, such as optimising your diet, exercise, sleep and relaxation, can also help you manage your symptoms.

While it can feel overwhelming at first to face both bowel cancer and menopause, it’s important to realise that you do have choices. Take time for yourself to check in and recognise your symptoms, and to read up on as much as you can so that you can have ongoing conversations with your healthcare professional about how best to access support. Be active in your recovery by learning about your options, including lifestyle management and complementary therapy, so that you feel in charge of your life.

References

Cancer Research UK
Bowel Research UK
Rawla P, Sunkara T, Barsouk A. (2019), ‘Epidemiology of colorectal cancer: incidence, mortality, survival, and risk factors’, Prz Gastroenterol. 14(2):89-103. doi: 10.5114/pg.2018.81072
Grodstein, F., Newcomb, P. A., Stampfer, M. J. (1999), ‘Postmenopausal hormone therapy and the risk of colorectal cancer: a review and meta – analysis’, American Journal of Medicine, 106(5) pp. 574–82. Doi: 10.1016/s0002-9343(99)00063-7
Sarmento ACA, Costa APF, Vieira-Baptista P, Giraldo PC, Eleutério J Jr, Gonçalves AK. (2021), ‘Genitourinary Syndrome of Menopause: Epidemiology, Physiopathology, Clinical Manifestation and Diagnostic’, Front Reprod Health. 15;3: 779398. doi: 10.3389/frph.2021.779398