Menopause often brings more than physical changes. It also may bring uncertainty about cancer risks and cancer prevention.

Below, I’ve compiled some of the questions I frequently hear from patients about menopause and cancer. I hope these answers will help other women start informed conversations with their doctors about menopause-related concerns.

How does menopause affect a woman’s cancer risk?

Menopause does not cause cancer. But your risk of developing cancer increases as you age. So women going through menopause have a greater chance of developing cancer because they’re older.

How does the age at which a woman starts menopause affect her cancer risk?

Starting menopause after age 55 increases a woman’s risk of breast cancer and endometrial cancer. That’s probably because she’s been exposed to more estrogen. During a woman’s menstrual cycle, estrogen stimulates the uterus and breast tissue. So the more menstrual periods a woman has, the longer these tissues are exposed to estrogen.

Women who start menopause later also may have an increased risk of ovarian cancer possibly because they have had more ovulations.

Some women receive hormone therapy (HT) to cope with menopause symptoms. How safe is HT?

I encourage women to try safer alternatives before using HT. Postmenopausal use of HT increases a woman’s risk of breast cancer.

The Women’s Health Initiative showed that women who took combined hormone therapy (estrogen and progestin) had a bigger risk of breast cancer. There also may be a higher risk for women taking estrogen alone, but study results on this risk are still inconclusive.

Some studies also suggest that using HT after menopause may slightly increase ovarian cancer risk. Generally, the longer you use hormone therapy, the more your cancer risk appears to increase.

That said, one study actually showed that women who used HT had a smaller risk of colorectal cancer. But the increase in breast cancer risk is still bigger than the decreased risk for colon cancer. So HT risks tend to outweigh any benefits.

Speak with your doctor before using hormone therapy. Make sure you understand all the benefits and harms before you start taking them.

What are some safer HRT alternatives that you recommend?

Even small lifestyle changes can make a big difference. For instance, you may have terrible hot flashes if you drink coffee before showering. But your hot flashes may not be nearly as bad if you try drinking coffee after showering.

Some safe and healthy ways to manage menopause symptoms include:

• Exercising regularly
• Increasing calcium and vitamin D in your diet
• Reducing stress
• Getting enough sleep
• Avoiding hot flash triggers like coffee, tea and alcohol
• Quitting smoking

If lifestyle changes don’t help, women may wish to talk to their doctor about anti-depressants. Certain anti-depressants tend to reduce frequency and intensity of hot flashes. And they curb moodiness and irritability associated with menopause, so they make help women who use them feel better.

Anti-depressants don’t help with a common menopause symptom — vaginal dryness, though. Many over-the-counter moisturizers and lubricants can help with this. But they only work if you use them on an ongoing basis.

What can women do to reduce their cancer risk during and after menopause?

The same ways you reduce your cancer risk before menopause: exercise, eat a healthy diet, don’t smoke and avoid secondhand smoke, and maintain a healthy body weight.

Research shows that gaining weight after menopause increases a woman’s risk of breast cancer, but losing weight after menopause can actually reduce your risk.

Therese B. Bevers is medical editor of The University of Texas MD Anderson Cancer Center’s Focused on Health.

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