Q & A - Menopause
These questions were suggested by people in Ireland who have been impacted by cancer. The answers were collected from experts based in Ireland.
“I’m going to have a hysterectomy. What should I expect?”
Abby Kiernan - Women’s Health Clinical Nurse Manager:
“A hysterectomy is the surgical removal of the uterus and in most cases the cervix. It means that a person will no longer have periods or be able to carry a pregnancy.
Recovery for most hysterectomies is 6 weeks. Your type of hysterectomy will depend on the reason for the hysterectomy. It may involve the removal of the ovaries and the fallopian tubes as well. In some cases (where cancer is of gynaecological origin) it may require more extensive surgery. This will be fully discussed with your consultant. Be sure to have a list of questions ready for your consult and do not hesitate to reach out to the nursing staff if you have further questions.
It is normally recommended that you refrain from inserting anything into the vagina after a hysterectomy (this includes tampons, pessaries or engaging in sexual activity) until you have been told healing is satisfactory. Follow-up is normally around 6-8 weeks after your procedure.
The vagina retains its sexual function and for most, they return to their normal sexual activity with no issues. Start slow and use a lubricant. Be sure to listen to your body and stop if you are experiencing pain or bleeding.”
“How can I help my partner understand the impact of Menopause? I feel like my whole personality has changed!”
Yvonne O’ Meara - Psychosocial Oncologist & Systemic Psychotherapist
“The experience of menopause is different from everyone. You may have a treatment/surgical induced menopause as a result of the cancer treatment or you may have been in menopause before the cancer diagnosis. Providing your partner with factual information about the menopause would be a great starting point. You can direct them to create a profile on thisisGO.ie and hear from the experts how it can impact an individual.”
“My employer is pushing me to go on HRT but my GP is advising against it. What should I do?”
Yvonne O’ Meara - Psychosocial Oncologist & Systemic Psychotherapist:
“Nobody should be “pushing” you into taking HRT unless you feel it is the right thing for you to consider. Your employer does not manage your hormones and your GP may not have all the answers either. Your Oncologist or Gynecological Oncologist would be the most suitable person to discuss your eligibility about taking HRT and weighing out the pros and cons for you, but ultimately it is your decision.”
Abby Kiernan - Women’s Health Clinical Nurse Manager:
“Your employer should not be pushing you to go on HRT. Many women can find working during perimenopause and menopause more difficult in light of symptoms like brain fog, fatigue, and managing hot flushes in a working environment. If you are comfortable doing so it may be worthwhile understanding why your employer feels you need to go on HRT (for example - is your work being affected by your symptoms).
Your manager should be putting provisions in place to allow you to continue to work around these symptoms, not asking you to go on HRT. HRT may not be an option for you or it may not be something you wish to start. Workplace awareness of menopause is increasing. Does your workplace have an occupational health service? Is there someone in the human resources department you could reach out to? It would be worthwhile reaching out to these members of your team to discuss your concerns.”
“I feel like I’ve lost part of my womanhood. How can I feel like me again?”
Yvonne O’ Meara - Psychosocial Oncologist & Systemic Psychotherapist
“Cancer leaves its mark in all aspects of our lives. A longing for the old you is very normal but may not be possible. Our physical, social, financial and psychological states can all be impacted both in the short term and long term, all of which can influence how we view womanhood. Having a hysterectomy can impact us in many different ways, there are many studies out there that state most women experience little to no change or improved sex after hysterectomy. This can be as a result of reduction of pain and discomfort for gynecological conditions post hysterectomy. If you had painful sex or bleeding these can improve after hysterectomy. For some women the psychological impact of having a hysterectomy can leave its mark and may influence how you feel about sex and your physical experience of it. It is important that you take time to explore the new norm while exerting compassion towards yourself. It can be really helpful to talk to a therapist outside of your family/friend unit to help you navigate this new norm and grief for the old.”
“How can I deal with vaginal dryness and other symptoms?”
Abby Kiernan - Women’s Health Clinical Nurse Manager
“Vaginal dryness is a very common issue experienced by those undergoing treatment for gynaecological cancers or pelvic radiotherapy. Symptoms can include vaginal irritation, itch, frequent thrush or bacterial vaginosis, urinary frequency or more frequent UTI. It can also cause pain during penetration or sexual activity.
Vaginal oestrogens can be very beneficial for those suffering with vaginal dryness. They help with maintaining healthy vaginal tissues and environment. Healthier vaginal skin means more comfortable sexual activity, easier cervical smear screening and reduces the risk of infections like thrush or BV. With that being said it is not always suitable for patients to use especially if you have a hormonally driven cancer.
Non-hormonal treatments for vaginal dryness include vaginal moisturisers/ creams which are similar to the idea of using a moisturizer anywhere else on the body. Most are available over the counter and you can ask you pharmacist for advice. Regular use of these products is the key, so incorporate it as part of your self-care routine. These products can be used as an alternative or in conjunction with vaginal oestrogens.”
“My skin is so sensitive. What products can I use to make touch and sex easier?”
See ThisIsGo Vulvovaginal health guide: https://thisisgo.ie/flipbook/vulvovaginal-health-guide/
My GP is insisting I not go on HRT. I’m heartbroken over it. I want my sex drive back. What can I do?
Emily Power-Smith - Sexologist & Educator
“Get a second opinion from a specialist. And make sure they are a specialist and that their CPD in up to date.”
Yvonne O’ Meara - Psychosocial Oncologist & Systemic Psychotherapist
“The most suitable person to talk to about your eligibility in taking HRT would be your gynecological oncologist or oncologist. If you are not eligible to take HRT due to your specific cancer subtype and the increased risk of a cancer recurrence, there are other non hormonal ways of increasing your desire - please see thisisGO.ie for useful advice on how to improve your desire: https://myprofile.thisisgo.ie/articles/cancer-sexuality-and-women/
Abby Kiernan - Women’s Health Clinical Nurse Manager
“Libido is multifactorial and whilst our hormones have a big role to play in ‘turning us on’ there is many other factors to consider when it comes to your sex drive. You have been through cancer treatment which is hugely stressful and can be all consuming. Changes to your body may have affected your confidence or body image. These things are all normal experiences but can frustrating or upsetting. See the SCI body image section for tips and advice on body image.
Menopause symptoms can include night sweats, hot flushes and problems sleeping. Tiredness is a killer of libido so try incorporate a good night routine and sleep hygiene: Sleep problems - tips and self-help - HSE.ie. Night sweats and hot flushes can understandably be a bit of a mood killer. Be reassured that there are non-hormonal treatment options for these symptoms that your GP may be happier to prescribe.
Your GP may be hesitant to start you on HRT for a number of reasons and unfortunately maybe hormonal treatments are not an option for you. This does not mean there are not alternative treatments. Looking into supplements and more natural forms of HRT may be another suitable way. Always discuss with your oncology team before commencing anything new. You may also be better managed at a specialist menopause hub or there are complex menopause clinics in a number of the Maternity Hospitals.
Cancer treatments and hospital stays can also mean that you are left feeling ‘touched out’. Being in hospital means that your personal space has been invaded a lot more than usual. This can have an effect then on intimacy. Start slow and reintroduce intimacy, hugs, foreplay and move away from pressures of intercourse being the main goal. Planning a date night, sending a flirty text message. Introducing toys in to the bedroom can also be fun ways to bring back excitement and conversation around sex and pleasure.
Be kind to yourself and your partner. By the sounds of it you are still interested in engaging in sexual activity, this is the first step.
See information on managing sex and intimacy during and after gynecological cancer treatments: