Last week (November 7 and 8), I tuned in to Ovarian Cancer Canada's two-night National Symposium, which featured some excellent presentations. One that stood out for me was The mysteries of menopause, explained (available on Ovarian Cancer Canada's YouTube channel). Ovarian cancer survivors Alvina Nadeem and Lynda Bungay shared their experience with abrupt menopause brought on by their cancer treatment, and Dr. Michelle Jacobson, medical oncologist and menopause specialist with Mount Sinai Hospital, offered her expert advice.

Even though I did not experience menopause as part of my treatment for ovarian cancer—having gone through menopause before being diagnosed—I found the topic fascinating and the advice applicable to just about anyone. If you've experienced menopause—be it abrupt or natural—you will find value in viewing the entire video of the discussion. If you haven't but want to better advocate for yourself in medical discussions, read on.

First a little context: Dr. Jacobson said that the symptoms of premature menopause caused by surgery, chemotherapy or medications to induce menopause are much more abrupt than those experienced by people who go through menopause naturally and gradually. Because those experiencing premature menopause go from ordinary ovary function to non-detectable levels of estrogen, testosterone and, for half the month, progesterone, their symptoms can last longer and be much more bothersome.

Here are four key messages that Dr. Jacobson delivered that could be applied to circumstances beyond menopause, whether premature or natural.

In response to a question from Alvina about distinguishing between symptoms of menopause and side effects of chemotherapy (she wanted to know which are likely to endure and which are likely to disappear as she recovers from cancer treatment), Dr. Jacobson identified a range of symptoms and side effects: hot flashes, night sweats, heart palpitations, anxious feelings, irritability, changes to the hair and skin, and joint aches. "You don't really know what's going to linger until the chemo is all out of your system and you've recovered in a physical and emotional way where you have a new baseline," Dr Jacobson said. "But that doesn't mean that you have to suffer in the interim because the symptoms of menopause can be addressed—they can be treated. I think what has to change is the expectation, because you may not go back to feeling the way you did before your cancer diagnosis, so there's going to be a new normal. And our goal would be to get that new normal as good and as quality-of-life fulfilling as possible."

The options for people who were premenopausal at the time of treatment depend on the type of ovarian cancer they had, said Dr. Jacobson. Hormone replacement therapy may be an option for some but not for others. For those who cannot take hormone replacement therapy, she said, alternatives may include medication, acupuncture, paced breathing, and cognitive behavioural therapy as well as general activities that everyone could benefit from, such as mindfulness, exercise and maintaining a healthy body weight. She made reference to 2023 guidelines from the North American Menopause Society on the non-hormonal management of menopause symptoms. "If you can access a menopause specialist, then I think it behooves you to do so because you'll get an individualized assessment."

In response to a question from Lynda about risks for osteoporosis and cardiovascular disease, Dr. Jacobson said that anyone who goes through premature menopause should have their bones assessed. She likes to do it about a year after treatment when the body has reached its new baseline. The results of a bone density test allow healthcare professionals to make recommendations about how to optimize one's bone health and how often one should have screening. With respect to cardiovascular disease, she noted that there is a long time between premature menopause and when cardiac disease may develop, so she characterized this as a risk.

"It's a risk factor you can't change or a non-modifiable risk factor. So just like a family history of cardiac disease, this is one of those things. You can't change how old you were when you got your period for the first time. You can't change your family history of cardiac disease. You can't change the fact that you went through menopause early because of your cancer treatment." But here's her advice, which is relevant to all of us: "So what can you change? You can change the amount of alcohol you drink. You can change whether you're a smoker. You can change how often you exercise and the foods you eat. And your diabetes control, and your blood pressure management—these are all things that have a huge impact on cardiac disease and cardiac disease outcomes. Yet people who are not faced with the fear of cardiac disease don't pay much attention to them at all.... So this is for you guys an opportunity to say 'This is something I'm worried about, so how can I optimize all the things that I do have control over?'"

Lynda shared that when she tells others that she's in menopause, some say, "Ah, you're too young. No you're not." Then she tells them she had ovarian cancer and they counter with, "Well, it's just menopause." Lynda asked for tips on how to explain to other people what she's going through.

"My overall impression is that people...say the wrong thing." She said that her pregnant patients are frequently told that they're too big or they're too small, that they must be having twins or that they look full term. "People all say the wrong things," she repeated, adding, "What I've started doing is looking at people and saying 'Why would you say that?'" She recommended an approach that she advises her children to take: say in the nicest possible way: "You're hurting my feelings. Can you stop doing that please?" She pointed out that "People may not realize that what they're saying is lacking in empathy."

As part of the previous topic, Dr. Jacobson stated: "I do think it's time for us to start recognizing how menopause can impact your functioning in the workplace." She referenced a paper that the Menopause Foundation of Canada recently published about the way menopause symptoms affect women at work. She added: "Menopause specialists around the country are constantly saying that menopause is having a moment. But your menopause should have an even louder moment than maybe even natural menopause. And natural menopause is only getting its air time for the first time now. So we're really at the beginning of spreading awareness for what you're going through."

I loved listening to Dr. Jacobson and appreciated hearing the lived experience expressed by Alvina and Lynda. I would recommend The mysteries of menopause, explained as well as sessions on Getting your ZZZZs: How to improve your sleep with ovarian cancer (which includes advice of relevance to people who don't have ovarian cancer) and on Creating a legacy through memory making, story telling and advocacy.