Cervical cancer and the menopause

Understand how cervical cancer treatment can affect the menopause

Early symptoms of cervical cancer can be confused with other conditions, including the perimenopause
Treatment for cervical cancer can trigger menopausal symptoms
Women treated for cervical cancer are able to take HRT to ease symptoms

Cervical cancer is when abnormal cells in the lining of the cervix (the opening between the vagina and the uterus) grow in an uncontrolled way. Nearly all cervical cancers are caused by an infection from certain types of human papillomavirus (HPV).

Most people who are sexually active will become infected with HPV at some point of their lives but most HPV infections go away on their own within a year or two as the immune system controls the infection. However, when a high-risk HPV infection lasts for years, it can lead to changes in the cells, resulting in a precancerous lesion that can then develop into cervical cancer.

Other known risk factors for cervical cancer include smoking, early age at first sexual intercourse, multiple sexual partners, the presence of other sexually transmitted diseases and a compromised immune status [1]. Taking the contraceptive pill for more than five years is associated with a slight increased risk of cervical cancer, but the risk begins to drop as soon as you stop taking it [2].

According to Cancer Research, cervical cancer is more common in younger females and most cervical cancer cases diagnosed in the UK each year are in females aged 30 to 34 [3].

What are the symptoms of cervical cancer?

In its early stages, cervical cancer often has no symptoms. When symptoms are present, they usually include: vaginal bleeding that’s unusual for you, changes to vaginal discharge, pain during sex, pain in your lower back, between your pelvis or in your lower tummy.

These symptoms are very common and can have other causes – for example, if you have fibroids or endometriosis. And during the perimenopause your periods can change and become unpredictable. It’s important to get any of these symptoms checked out by a doctor to help determine the cause.

How can cervical cancer affect menopause?

If you have not had menopausal symptoms before your cancer treatment, you may find that the treatment – for example, radiotherapy, surgery to remove your ovaries and some chemotherapy drugs – brings on an early menopause.

Menopausal symptoms after treatment for cervical cancer can be more sudden and intense than if you went into a natural menopause. For example, surgery, such as a hysterectomy, will immediately trigger the menopause, while pelvic radiotherapy can damage your ovaries, which can trigger the menopause – usually about three months after cancer starts.

Ideally you should be supported by your healthcare team regarding the menopause before your cancer treatment starts, but sadly this doesn’t always happen. Ask to speak to a menopause specialist at the hospital where you are receiving treatment.

How can I treat my menopause after cervical cancer?

HRT is the first-line treatment for symptoms of the menopause. When people experience an early menopause, including through cancer treatment, it’s advised to take HRT to replace the hormones your ovaries would naturally be producing, until around the age of 51 (when the menopause would usually start). You can then review it, depending on your symptoms and risks.

If you’ve had a hysterectomy, you’ll be offered oestrogen-only HRT (women who still have a womb need combined HRT). A review of studies found there is no evidence of a harmful effect of HRT on cervical cancer oncological outcome, and several benefits – such as reduced metabolic risk and increased quality of life – were reported [4].

HRT is an effective way of helping menopause symptoms but if you’ve had radiotherapy, you may have side effects such as vaginal shortening and narrowing, and sensitivity of the lining of the vagina. Vaginal oestrogen can be effective in treating symptoms.

References

Shiraz A, Schiemer R, Staley H, Matsushita T, Hasegawa T, Bryant A, Inoue E, Egawa N, Gajjar KB. (2023), ‘Human papillomavirus (HPV) self‐sampling to encourage the uptake of cervical screening’, Cochrane Database of Systematic Reviews, Issue 11. DOI: 10.1002/14651858.CD014502.
Cancer Research: cervical cancer risks and causes
Cancer Research: cervical cancer risks and causes
Vargiu V, Amar ID, Rosati A, Dinoi G, Turco LC, Capozzi VA, Scambia G, Villa P. (2021), ‘Hormone replacement therapy and cervical cancer: a systematic review of the literature’, Climacteric. 24(2):120-127. doi: 10.1080/13697137.2020.1826426