Menopause

Key people: Prof Martha Hickey, Soula Krejany, Tracy Middleton

Overview

Menopause is a natural event for every woman.  Also known as ‘the change of life’ or simply ‘the change’, it marks the end of a woman’s ability to conceive.

Menopause is defined by a woman’s last menstrual period. A woman is said to be “post-menopausal” if there has been no period for 12 consecutive months. Menopause can happen naturally or as a result of some health conditions, medication or surgical procedures.

When a woman’s period stops permanently before the age of 40, she is said to have premature menopause.

The average age at menopause is 50, but it can occur earlier or later. The most common symptoms are changes in menstrual patterns, vaginal dryness, hot flushes and night sweats.

Understanding what symptoms to expect, realising that most women are able to deal with their symptoms without treatment, and having a more positive outlook on menopause are helpful in managing this normal life stage.

Menopause can be prematurely induced by cancer treatments such as surgery, chemotherapy, endocrine therapy and pelvic or whole-body radiotherapy. Cancer survivors have been observed to experience symptoms such as hot flushes more frequently and severely than non-cancer patients. The symptoms can be distressing, and in some cases, persist for a long time after treatment has ended. Younger women with cancer may experience these symptoms for many years before they had expected to, which can lead to concerns about the impact on fertility. Older women with cancer may experience menopausal symptoms all over again, years after symptoms of their natural menopause subsided. Some women who do not have cancer, but who are at high risk of developing ovarian cancer may have to consider preventive surgery to remove the ovaries (oophorectomy). It is believed that the menopausal symptoms induced by an oophorectomy are likely to be more severe than in natural menopause.

Research projects

Women’s Health After Surgical Menopause - WHAM Study

Key people: Prof Martha Hickey, Soula Krejany, Tracy Middleton

Clinical trial

Women who carry the BRCA1 or BRCA2 gene mutations, carry gene mutations associated with Hereditary Non-Polyposis Colorectal Cancer (Lynch Syndrome), or have an extensive family history of cancers linked to these mutations are considered to have a higher lifetime risk of developing ovarian cancer than the average woman in the population. An effective early detection test for ovarian cancer does not currently exist. Also, annual screening procedures for ovarian cancer via transvaginal ultrasound, CA125 and other biomarkers have not proven effective in detecting tumours at a sufficiently early stage to substantially influence survival. The only intervention that has been shown to significantly reduce the incidence of ovarian cancer (and breast cancer) in these women is a surgery that removes the normal fallopian tubes and ovaries, salpingo-oophorectomy. The surgery comes at a cost, however, as it will initiate premature ‘surgical’ menopause, end fertility and, for many young women, trigger severe sexual dysfunction.

In a world-first study, Women’s Health After Surgical Menopause, an international study led by Professor Martha Hickey is investigating the short and long-term health consequences of surgical menopause, which is thought to be more problematic than natural menopause. No previous large studies have prospectively followed women from before surgical menopause to measure key physical and psychological outcomes affecting health and wellbeing.

Across five sites in Melbourne, Sydney and the USA, the WHAM study is currently recruiting premenopausal women undergoing risk-reducing oophorectomy because of a high familial risk and/or high inherited risk of ovarian cancer. This study will address outcomes of direct clinical and translational importance by collecting data over a two-year, post-surgery period that relates to sexual function, menopausal symptoms, sleep quality and mental, bone and cardio-metabolic health. The study is controlling for the effects of age and lifestyle by concurrently recruiting age-matched premenopausal women not planning to undergo surgical menopause.

The findings of this study will provide new evidence to inform decision making around surgical menopause for high risk women and those considering the surgery for other indications. They will also address the knowledge gap and inform new international evidence-based guidelines for surgical menopause.


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