Menopause age

Cancer can develop on the inside lining of the uterus, called the endometrium. Fewer than 3 in 100 women past age 50 will develop endometrial cancer in their remaining lifetime, and far fewer will die from the disease. When detected while the cancer is still localized, white women with endometrial cancer have a 5-year survival rate of 96% and black women about 86%. (Naturally, women who have undergone hysterectomy have no risk for endometrial cancer.)

Risk factors for developing endometrial cancer include use of estrogen without progestogen, use of tamoxifen (for breast cancer therapy), menarche (starting periods) earlier than age 12, late menopause (after age 51), not ovulating regularly during menstrual years (excluding pregnancy and lactation), infertility or never being pregnant, obesity, diabetes, gallbladder disease, and, perhaps, high blood pressure and hereditary colon cancer. Previous pregnancy and oral contraceptive use appear to provide some protection against endometrial cancer.

Annual pelvic exams are recommended for all women. If a woman has risk factors for endometrial cancer, including unexplained abnormal uterine bleeding, an endometrial biopsy may be recommended as well.

The Pap smear, which is so effective in detecting cervical cancer, is not a reliable test to detect uterine cancer. Transvaginal ultrasound and sonohysterography (an ultrasound view of the uterus, sometimes with the uterus filled with salt water) are being used by some clinicians to determine the thickness of the endometrium and to look for endometrial cancer and other causes of postmenopausal or abnormal uterine bleeding.

Role of ET/EPT

Using estrogen without a progestogen—also called “unopposed” estrogen therapy or ET—for 3 years or more has been associated with a marked increase in endometrial cancer. Most endometrial cancers that occur while taking unopposed ET are low-grade cancers and do not reduce a woman’s lifespan if detected early and treated with hysterectomy.

Adding the proper type and amount of progestogen to estrogen counteracts the increased risk of endometrial cancer, reducing the risk to the level of taking no hormones at all. As a result, most experts recommend that all women with an intact uterus should use a progestogen with ET.

The Wisdom of Menopause: Creating Physical and Emotional Health and Healing During the Change, 2nd Edition

From Publishers Weekly:
Northrup (Women’s Bodies, Women’s Wisdom), cofounder of the Women to Women health-care center in Maine, offers a celebratory, “psychospiritual” approach in her comprehensive guide to menopausal health and well-being. Beginning with the premise that, though difficult, the “hormone-driven changes that affect the brain… give a woman a sharper eye for inequity… and a voice that insists on speaking up,” Northrup details hormonal imbalances, mood swings, serious illnesses, treatment options and all the other symptoms, side effects and decisions women face in midlife.

Menopause is not associated with increased cancer risk. However, some cancer rates typically increase with age, so postmenopausal women should be informed about the most common cancers that may affect them. Also, some of the therapies used to treat menopause symptoms are associated with an increased or a decreased risk for certain types of cancer.

Breast cancer is perhaps the cancer women fear most. This fear comes not only from the possibility of dying from the disease, but also from the rigorous demands of treatment and the probability of cancer recurrence.
Moreover, many midlife women have personally seen relatives or friends go through breast cancer treatment or have lost loved ones to the disease.
Fortunately, the percentage of women dying from breast cancer has started to decline in recent years.
Smaller, less-advanced cancers can now be detected earlier with mammography.

Role of ET/EPT

Current data support a link between an increased risk of breast cancer and using one type of hormone therapy— estrogen combined with a progestogen (EPT)—particularly after several years of use.
Women without a uterus who use estrogen therapy (ET) alone may not have this risk.
Shorter term use of ET or EPT during perimenopause to relieve hot flashes and other menopause-related symptoms does not appear to increase breast cancer risk. All ET and EPT products are contraindicated in women with known or suspected breast cancer as well as in those with a history of breast cancer.

Early detection

Since many breast cancer risk factors cannot be altered, early detection is the best strategy. Some experts recommend annual mammograms beginning at age 40, as well as before starting hormone therapy, while others recommend longer intervals.
All agree that women over 50 should have a mammogram every 1 to 2 years. The value of mammograms in detecting breast cancer is affected by several factors.

The value of mammograms in detecting breast cancer is affected by several factors.
For example, high hormone levels cause breasts to appear more “dense” (or cloudy) on a mammogram, making the test more difficult to interpret. In women before menopause, when hormone levels are high, mammograms are harder to read and have more false positives. Hormone therapy also makes breasts appear denser on a mammogram.

For postmenopausal women using EPT, the best time for a manual exam and mammogram is immediately after therapy-induced uterine bleeding stops. Breast density remains consistently high for women on continuous combined EPT or for those using estrogen alone, although density is less the more years beyond menopause.

Studies repeatedly show that early diagnosis of breast cancer is linked to higher cure rates.