Blood cancer and women’s issues

Our Nurse Advisor, Fiona Heath, has written an article on the specific blood cancer issues that affect women, including sex-specific symptoms, and how a diagnosis can affect menopause and pregnancy.

Symptoms of leukaemia which can affect both women and men include fatigue, weakness and breathlessness, fever, bleeding and bruising, joint or bone pain and frequent infections. In addition to this, women may experience sex-specific symptoms.


Cancer symptoms and heavy menstrual bleeding

Although heavy periods are common, and there are many causes, some heavy periods could be a sign of blood cancer.

Women may notice an uncharacteristic bleed midway through their menstrual cycle. This is usually more than a little routine spotting that they may have experienced in the past. Some women with leukaemia also experience heavy menstrual flow during their period as a symptom of their condition.

Leukaemia is a cancer of the white blood cells. When the white blood cells multiply abnormally, they take over the bone marrow and displace the cells that make the red blood cells. Platelets also become displaced, and platelets are the cells that help the blood to clot. Therefore, this can cause women to experience heavy periods as their platelet levels may be low.

Cancer treatment can also affect menstruation; women may find that their periods stop, become irregular, or sometimes much heavier and longer in length. Chemotherapy can cause low platelets which in turn may cause heavy vaginal bleeding. Medical teams will often prescribe medications to stop a woman’s period before commencing treatment. These medications can help to prevent heavy bleeding and blood loss when platelets are low.


Cancer symptoms and the menopause

After menopause, a woman’s ovaries stop producing the hormone oestrogen. As a result, women may experience menopausal symptoms including hot flushes, night sweats and fatigue. Although these are common symptoms of the menopause, they can also be an indication of a blood cancer. Therefore, menopausal symptoms could possibly mask a blood cancer diagnosis. Although blood cancer is very rare, it is important to have any symptoms checked with your GP.


Early menopause

Some cancer treatments can affect the normal functioning of the ovaries. This can sometimes lead to infertility and an earlier than expected onset of menopause, even at a young age. The onset of menopause in these circumstances can be sudden and, understandably, very distressing. Hormone changes can lead to many of the classic symptoms of menopause, including menstrual changes, hot flushes, sweating, dry skin, vaginal dryness and itchiness, headache and other aches and pains. Some women experience decreased sexual drive, anxiety and even depressive symptoms during this time. Women may need to see a gynaecologist, who will advise them on the appropriate steps to take to reduce their symptoms.

Menopausal symptoms can be particularly troubling for some women. In these women, hormone replacement therapy (HRT) can be helpful. The aim of HRT is to restore oestrogen levels to near normal, minimising symptoms.


Cancer symptoms and pregnancy

Pregnancy does not change the symptoms of cancer, but the changes that happen to a woman’s body during pregnancy may delay a blood cancer diagnosis. This is because some cancer symptoms may be similar to changes that happen during pregnancy.

For example, fatigue is a common symptom of pregnancy, but it is also associated with blood cancers. Women can have some vaginal bleeding during pregnancy, but this can also be a blood cancer symptom. If you have any symptoms that could be linked to cancer, it is important to get them checked by your GP. You should have the same checks as if you were not pregnant.


Myeloproliferative Neoplasms and Women

Myeloproliferative neoplasms (MPNs) can affect both men and women. However, there are some specific issues that affect women who are diagnosed with an MPN.

Contraceptive Pill

For a patient with an MPN, it is important to consider the options when deciding which contraceptive pill to take. The progesterone-only pill is safe for women who have an MPN to take; however, it is important to note that the use of the combined oral contraceptive pill is not appropriate for women who have an MPN due to the increased risk of blood clots (venous thrombosis).

Family Planning

MPNs can increase the risk of miscarriage in both early and late pregnancy. It can also put a woman at greater risk of developing pregnancy complications such as pre-eclampsia.

It is important for women who have an MPN to have a discussion with their haematologist if they are planning to become pregnant. If a woman takes aspirin only or aspirin combined with phlebotomy/venesection, then this treatment plan does not normally need to be adjusted for family planning.

However, if treatment has involved drugs such as hydroxycarbamide or anagrelide, then this treatment will need to be stopped as these drugs can interfere with foetal development. It is recommended that these drugs are stopped at least six months before becoming pregnant or fathering a child, as they take some time to be completely eradicated from the body.

Other treatments that are safer for pregnant women include aspirin and interferon and/or heparin injections. Some women do not need any treatment whilst they are pregnant as their blood volume increases during pregnancy. The most important thing is to discuss family planning with your haematologist so that they can plan for these medication adjustments in advance.

Having an MPN does not prevent women from having children. If the pregnancy is carefully planned and the pregnancy and birth are monitored, there is no reason why women with MPNs should not have babies. The most important factor is working closely with the haematologist to ensure that women stay healthy and safe, and that complications or medication adjustments are carefully planned for and monitored.

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