Understanding Multiple Myeloma & Menopause
- Canadian-born actress and model Lisa Ray, 54—who is navigating life with multiple myeloma, a rare blood cancer she was diagnosed with in 2009 that triggered chemo-induced menopause at age 37—is encouraging women to embrace menopause, stressing that the transition is “not a disease” and that women are “not broken.”
- Dr. Stephanie McNally, Medical Director for Katz Institute of Health at Northwell Health, previously clarified to SurvivorNet that menopause is the point at which a woman has gone 12 months without a period, while perimenopause is the transition leading up to it.
- Multiple myeloma is a rare type of blood cancer that hinders the body’s ability to fight infections. It can cause weakness, dizziness, bone pain, and confusion, among other symptoms. Advancements in multiple myeloma treatments have improved the lives of patients battling the disease.
- It’s important to note that although this type of disease is manageable thanks to treatment advances, multiple myeloma patients face a higher chance of relapse (the cancer coming back), and maintenance treatment is often an important part of one’s cancer journey because it can extend periods of remission.
- There are a significant number of clinical trials being conducted for multiple myeloma and SurvivorNet has resources about how to access these options.
- For any other questions you may have, whether it be about menopause or cancer, explore SurvivorNet’s proprietary AI tool, “My Health Questions.”
The 54-year-old, who rose to fame in the 90s and has worked in Bollywood [the Hindi-language film industry], offered her wisdom on menopause in a recent conversation with film producer Mukul Deora, 51, on The Secret Sauce Podcast.
Read MoreDr. Stephanie McNally, Medical Director for Katz Institute of Health at Northwell Health, previously clarified to SurvivorNet that menopause is the point at which a woman has gone 12 months without a period, while perimenopause is the transition leading up to it.
RELATED: What’s the Difference Between Menopause and Perimenopause? A Leading OB/GYN Explains
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In response to Deora’s question about what people often misunderstand when it comes to menopause or perimenopause, Ray said, “The first thing that they misunderstand, there’s a lot of fear around it first of all, that seems to be the first reaction. First thing they understand is that it’s a disease, that somehow women are broken.
While preparing for the podcast interview, Ray recalled discussing perimenopause with her makeup artist, noting how a younger woman overheard the conversation and was surprised, asking, “Is it really that bad?”
Ray continued, “I realized I had to pull it back because I had to say, “look, it’s a transitional period. Yes, for some women it’s really difficult. You feel like your body isn’t your own. You feel like someone else has taken over your body. That would be alarming to anybody in the world.
“You feel like you’re going crazy. And especially if you have no one to talk to or you have no one who’s validating what’s going on inside you. Very isolating. Completely.”
However, she stressed that “it’s a transition that has a big payoff at the end of it,” better phrasing it as “you’re stepping into wisdom.”
“I think that perimenopause and menopause, if we can reframe it as a transition and as an invitation for women to actually, number one, pay attention to their bodies, possibly for some women the first time in their lives, because our attention goes to our family and our husbands and our duties and our work and everything except for ourselves.
Ray then described perimenopause as a time when women often have to stop putting their own needs aside and start prioritizing their health to navigate the transition.
“You have to attend to your body. Your body’s talking to you very loudly. So it represents that, but it also represents a transitional period where actually we are meant to move into something much greater,” Ray said.
She encouraged women to view perimenopause as a period of empowerment rather than a loss, describing it as a time to embrace confidence, wisdom, and personal growth.
“A woman should look at it as, ‘I’m walking into my power phase,'” she said. She added that women could also use “cute” words and call it their “queenager age,” framing the transition as an opportunity to celebrate themselves.
“I was invited into this world because of my cancer treatments. So basically I went into chemo-induced menopause at 37. At 37, yeah. When you are completely unprepared. And nobody had even mentioned also menopause to me,” Ray explained.
“Probably that was the first time I’d heard the word spoken out loud was when I was sitting with my oncologist, and they said, ‘okay, we’re preparing you for a stem cell transplant, And as a result of the high dose of chemo we’re giving you, you’re going to go into menopause.’ And it was a lot. I didn’t quite grasp it. I didn’t understand. And obviously the priority was to save my life.”
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Although she openly used her voice to advocate for people affected by cancer in the past, she revealed that she initially kept her menopause journey hidden.
She said she kept that chapter of her life private because of the shame and vulnerability surrounding women’s health issues, noting that, like cancer, menopause has long been affected by stigma and silence.
Expert Menopause Resources
- Menopause Keeping You Up at Night? Top OB/GYN Explains Why Sleep Matters More Than Ever
- Managing Menopause: Proper Nutrition Is Essential For Easing Symptoms
- Understanding Hot Flashes: One of the Most Common Symptoms of Menopause
- What’s the Difference Between Menopause and Perimenopause? A Leading OB/GYN Explains
Ray said that simply “not feeling like yourself” can be a meaningful sign that something is changing in your body, encouraging women to trust their bodies and know their concerns deserve to be heard.
“Now, of course, I believe, if I’m not mistaken … there are over a hundred [potential] perimenopausal symptoms. Now we’ve heard of the, you know, the typical ones, the hot flashes, joint pain, you know, a lot of weight gain, especially around the middle area, dry skin. But there’s a lot more that are less obvious or less categorized or less known,” she explained.
“For instance, itchy ears are a very, very prominent … because again, there are estrogen receptors in the skin of our ears, and then it drops and we find that it becomes itchy.”
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Ray admitted that severe vertigo [a feeling of spinning or loss of balance] was one of her most alarming menopause symptoms, and she didn’t realize it was linked to perimenopause until later on.
She explained further, “The point is, your body’s changing. Now, what is going on in your body? We have these three hormones, estrogen, testosterone, which is very important also for women, and progesterone. Now, what’s happening is they’re starting to fluctuate. They’re going up and down.”
Ray wants to help women recognize that menopause is a normal life transition, warning that without that understanding, many may mistakenly believe something is seriously wrong with them.
The Bollywood star then advised women to “tune into your body” and track symptoms.
Understanding Menopause and Perimenopause
“For a woman going through a natural hormonal transition, menopause, and I say natural meaning there’s no chemicals, there’s no surgery, there’s no chemotherapy, which obviously affects your patients differently,” Dr. McNally told SurvivorNet in an earlier interview.
“The average age in the United States is about 51 to 52, where your periods will stop. So it’s the full year without a period equals menopause. Menopausal is anything happening after, and perimenopause is the time leading up to that last period.”
Describing how the transition, for many women, can actually be a more challenging time, she says: “The perimenopausal transition has a lot more erratic changes in hormones where the eggs, the follicles that are still there may or may not ovulate. So this trigger from your brain, the hypothalamus, talking to your ovaries to get that egg matured and released is what triggers these hormonal changes.”
“And it’s like an accordion,” she added. “Things get really close to together in terms of a lot of eggs happening all at once and getting released. You’re getting a period, and then it spaces out. And it’s that transition. When you start skipping cycles, that’s really one of those signs that let you know you’re moving towards that menopausal piece, meaning one full year without a period.”
Dr. McNally explained that irregular periods are only one small part of what’s happening during perimenopause and menopause.
“Hormones are not just from your ovaries, they’re from your brain,” she said. “They’re circulating through your body. So the way that your body changes from perimenopause to menopause, it’s going to be individualized, it’s going to vary, and it’s going to affect every single aspect of your body.”
When it comes to the changes that arise in menopause and perimenopause, Dr. McNally said those changes can affect “everything.”
“It is starting at the head from mood to energy, to cognition, brain fog,” she said. “There could be a decline in word recall or the quickness in that perimenopausal transition—very well studied. It can lead to poor sleep, poor libido, poor coping mechanisms and hot flashes [a vasomotor symptom]. And that is actually a trigger from your brain.”
“As the estrogen declines, it becomes erratic where your brain is craving estrogen and your ovaries are like, ‘Yeah, I’m done. It’s not happening.’”
Dr. McNally further explained that perimenopause can last anywhere from two to 10 years and varies widely between individuals, with research showing differences in duration and symptom severity across ethnic backgrounds, making it a highly individualized process.
“It’s based on other medications, comorbidities—there’s a lot of factors, but for a small percentage of women, a premature menopause occurs before the age of 40,” she adds. “And a early menopause is between 40 and 45. So after 45 and beyond is considered normal. Average age is 51, below 40 is premature.”
Dr. McNally also noted that symptoms can begin in a woman’s early 30s, especially if she is on track for an earlier menopausal transition.
Understanding The Signs
Early and common perimenopause symptoms, according to Dr. McNally, may include:
- Breast tenderness
- Headaches
- Menstrual cycle changes
- Mood changes
Other physical, metabolic, and weight-related changes women may experience:
- Skin changes and itchiness (including itchy ears)
- Hair changes
- Changes in breast density
- Slower metabolism
- Belly weight gain despite healthy habits (diet, supplements, hydration, fiber, protein)
As for pelvic and urinary changes, as well as broader body effects, these may include:
- Urinary leakage
- Incontinence
- Vaginal dryness
- General pelvic health changes
- Joint discomfort
“All of the things from head to toe, front to back joints included, can be affected,” Dr. McNally emphasized. “Any body part can be affected because based on our biology, there’s an estrogen receptor everywhere in a female body. So as these hormones are changing, it can affect us all differently. And no body part is off limits.”
To reiterate, Dr. McNally said it is important to understand that it’s difficult to precisely predict what will happen during perimenopause versus menopause because each person’s experience is shaped by factors such as their body, ethnic background, and medications.
She concluded, “The menopausal state is really a depletion of our sex hormones, the estrogen, progesterone, and a portion of our testosterone, because testosterone is made not only in the ovaries, but in the adrenal glands.”
“So there are other sources of testosterone in our body, but essentially we’re talking about those main sex steroid hormones that are gone at any significant levels in that menopausal transition. That’s the difference, erratic and then absent in the menopausal state.”
Lisa Ray’s Battle & Maintenance Therapy for Multiple Myeloma
Reflecting on her 2009 cancer diagnosis, Ray once said, “My doctor was scared because after he announced to me that I had multiple myeloma, I didn’t react. Even though he said it was incurable and fatal. In my mind, I was thinking that my body has been trying to give me signals for months, and I was ignoring them…”
Ray continued, “Then I got this strongest possible message. Intuitively, I knew something was wrong. But I didn’t have the courage to do anything, because I was trained to ignore what my body was telling me.”
She ultimately underwent a stem cell transplant before reaching remission. However, she had a recurrence of the cancer in 2012.
Maintenance Therapy for Multiple Myeloma
All About Multiple Myeloma
Multiple myeloma is a rare and incurable type of blood cancer. When you have this cancer, white blood cells called plasma cells (the cells that make antibodies to fight infections) in your bone marrow grow out of proportion to healthy cells. Those abnormal cells leave less room for the healthy blood cells your body needs to fight infections. They can also spread to other parts of your body and cause problems with organs like your kidneys.
Sometimes, doctors find multiple myeloma while doing a blood test to look for another condition or when trying to find out what’s causing a patient’s unexplained symptoms.
Doctors use blood and urine tests and imaging tests, such as X-rays or MRIs, to help diagnose multiple myeloma and to guide treatment options. Ultimately, a bone marrow biopsy will confirm the diagnosis.
RELATED: Hematologist and SurvivorNet advisor, Dr. Nina Shah, helps you understand this rare cancer
Multiple myeloma symptoms can range from tiredness, nausea and constipation. Other symptoms may include:
- Weakness, dizziness, and shortness of breath, which are signs of a low red blood cell count, are called anemia.
- Bone pain, which could be a sign of a fracture.
- Urinating too much or too little, muscle cramps, nausea, and vomiting are symptoms of kidney failure.
- Confusion is caused by too much calcium in the blood.
- Frequent infections because you have too few white blood cells to fight them.
It’s important to know that these symptoms could be attributed to other conditions. If you experience any of these symptoms or are concerned about any changes to your body, you should address them promptly with your doctor.
Hematologist-oncologist Dr. Adam Cohen lays out your options during the maintenance phase of treatment
Meanwhile, multiple myeloma does cause bone conditions. According to the Multiple Myeloma Research Foundation, 85% of multiple myeloma patients have some kind of bone damage or loss.
“The most commonly affected areas are the spine, pelvis, and rib cage,” the Foundation explains.
The reason for this bone loss or damage is multiple myeloma disrupts the bone remodeling process. The cancerous myeloma cells keep the cells in the bone responsible for removing old bone and rebuilding new bone from working properly.
The disease can also weaken the bone, resulting in fractures. And it can cause thinning of the bones leading to osteoporosis [meaning the bones are more porous and more likely to fracture].
And “in advanced multiple myeloma, a patient may lose inches from his or her height due to compressed vertebrae over the course of their illness.”
So bone conditions can be a symptom of multiple myeloma.
RELATED: Why Do Some People With Cancer Experience Back or Bone Pain?
Getting a Diagnosis
Sometimes doctors find multiple myeloma while doing a blood test to look for another condition, or when trying to find out what’s causing a patient’s unexplained symptoms.
According to SurvivorNet’s experts, blood tests are also the way your doctor might learn that you have smoldering multiple myeloma or MGUS, because these conditions don’t usually cause symptoms. Smoldering multiple myeloma and MGUS aren’t cancer, but they can sometimes turn into cancer.
The odds that either condition will become cancer are very small, but to be safe, your doctor will probably check you more closely with blood and urine tests, and sometimes a bone marrow biopsy–removing and testing a small sample of the spongy material inside your bones. These tests can help monitor you for changes that signal you’ve switched over to multiple myeloma, and that you need to start treatment for this cancer. You may also need a bone marrow biopsy to help your doctor make the initial diagnosis.
Doctors use blood and urine tests and imaging tests such as X-ray or MRI to help diagnose multiple myeloma and to guide treatment options. Ultimately, a bone marrow biopsy will confirm the diagnosis.
Monitoring your bone strength and health over time will help your doctors understand how, or if, your disease is progressing.
Treatment Options For Multiple Myeloma
Not everyone with multiple myeloma needs treatment right away. If you have smoldering multiple myeloma, your doctor might simply monitor you regularly, to see if your disease progresses.
If you develop symptoms or your doctor thinks you need treatment, there are many options. Which of these treatments you receive, and how they are sequenced, depend on several factors, and on whether your treatment team thinks you are a good candidate for a bone marrow transplant.
Bone Marrow (Stem Cell) Transplant
This is also known as a stem cell transplant. It is a procedure to replace diseased bone marrow with healthy bone marrow without myeloma cells. Based on multiple factors, your doctor may decide that a stem cell transplant is best for you. The transplant process can be involved and requires multiple steps. Be sure to discuss this with your treating team to understand what is involved and what options are available.
If you’re not a good candidate for chemotherapy, your treatment options include targeted therapies, biologics, and steroids.
Targeted Therapy
Targeted therapy is now available for patients with multiple myeloma, and targets abnormalities in myeloma cells that allow the cancer to survive. Examples of targeted agents your doctor may use include bortezomib (Velcade), carfilzomib (Kyprolis), and ixazomib (Sarclisa). These drugs are either given in a pill or through an IV, and cause myeloma cells to die by preventing the breakdown of certain proteins in myeloma cells. You doctor may also use other targeted agents in the class of medications known as monoclonal antibodies.
Biologic Therapy
Biologic therapy is another class of medication your treatment team may use to treat your myeloma. These medications use your bodys immune system to help fight and kill myeloma cells. This class of medication is most often given in pill form and include medications such as thalidomide (Thalidomid), lenalidomide (Revlimid), and pomalidomide (Pomalyst).
Chemotherapy
Sometimes your treatment team may recommend chemotherapy to treat your myeloma. Chemotherapy uses strong medicine to target cancer cells throughout your body. If your doctor recommends a bone marrow transplant high doses of chemotherapy are used for this purpose.
Steroids
Occasionally, doctors may use corticosteroids such as dexamethasone or prednisone as part of your treatment. Steroids are different from chemotherapy, targeted therapy, and biologic therapy. They work to reduce inflammation throughout your body. Steroids are given as a pill, and are also active against myeloma cells.
Radiation
Radiation uses high-dose X-rays to stop cancer cells from dividing. It is sometimes used to target myeloma in specific areas that may be causing you issues or pain. It is also used if there are tumors or deposits of myeloma cells that need to be treated, such as a plasmacytoma — a tumor made of abnormal plasma cells — of the bone.
Sometimes the cancer can return, or relapse after treatment. If this happens, your doctor can put you on one of the treatments you’ve already tried again, try a new treatment, or recommend that you enroll in a clinical trial.
Any of these treatments can cause side effects, which may include nerve pain and fatigue. Your doctor can adjust your medication if you do have side effects. In general, you should start to feel better once your treatment starts to work.
Extending Your Lifespan With Multiple Myeloma
Then you’ll ultimately reach the maintenance phase of treatment. Now that your doctor has gotten your cancer under control, from here the goal is to keep your disease stable and to maintain your quality of life. Which type of maintenance therapy you get, and what prognosis you can expect, will depend on whether your doctor determines that your multiple myeloma is standard risk or high risk.
One of SurvivorNet’s experts describes the maintenance process for this disease as similar to lawn care. Once you care for your lawn and it’s no longer overgrown (that’s the initial treatment), it will need some tending but with that attention (such as low doses of maintenance drugs), it can remain healthy.
Why the many phases of multiple myeloma are like caring for your lawn, says hematologic cancer specialist, Dr. Sid Ganguly
Sometimes this disease will return, even when you’re on maintenance therapies. You’ll still have treatments available if this happens.
Though it can be daunting to choose treatments for relapsed multiple myeloma, the medical experts at SurvivorNet are here to help you make sense of them. Remember that you do have options, and that the goal which becomes more achievable with each new treatment that’s introduced is to preserve your quality of life and extend your lifespan.
Have Questions?
For questions you may have, whether it be about menopause or cancer, explore SurvivorNet’s proprietary AI tool, “My Health Questions.”
WATCH: How One Cancer Survivor and Her Sister Used “My Health Questions” to Navigate Care
This powerful resource, embedded across the SurvivorNet website, was built to bridge that gap by offering on-demand explanations of treatment options, clinical trials, side effects, insurance concerns, and more.
Users can ask questions in a conversational way, either by typing or by voice, and receive answers tailored to their individual profiles. If patients don’t know where to start, we provide prompt questions to get them started.
Contributing: SurvivorNet Staff
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