Managing medically induced menopause can be a huge shock, especially when you were expecting menopause to happen during your 50s. Lisa Punt from Maggie’s, a UK charity that offers cancer support and information, shares how support and knowledge can really help women deal with the triple impact of cancer diagnosis, treatment, and induced menopause.
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What does induced menopause mean?
Surgical menopause is when you have your ovaries removed. The most common reasons are due to cancer, to prevent ovarian cancer, or to decrease severe pain associated with endometriosis.
Medically induced menopause
Medically induced menopause is due to medication, typically chemotherapy, stopping your ovaries from functioning. Sometimes it is permanent, and sometimes it is not. Radiation treatment for cancer can also stop your ovaries from functioning.
- Ovary removal: Removing both ovaries, also known as oophorectomy, leads to permanent and immediate menopause
- Chemotherapy: Depending on the treatment type, it can be temporary and your periods stop while having treatment and recovering. In some cases, it can be permanent
- Radiotherapy: Induced menopause risk is higher if your treatment is in or near your pelvis. In some cases, the ovaries can be relocated higher up in the abdomen if the pelvis needs radiation to reduce the risk
Is induced menopause permanent?
Induced menopause can be permanent or temporary, depending on your diagnosis and type of treatment. It can be distressing to go through getting a diagnosis, undergoing significant treatment, and then also having to deal with menopause symptoms.
75% of people will have treatment for fatigue for two years post-treatment. No one tells you that and this is when psychological distress may hit.”
Induced menopause symptoms
Induced menopause causes the same symptoms as spontaneous menopause. There are over 34 menopause symptoms and you may get some or many of these – each experience of menopause is unique. If you are in menopause after a hysterectomy or have induced menopause, you might experience the following symptoms:
You will need specialist support if you are going through induced menopause. Symptoms can be more intense than spontaneous menopause, and the consequences on long-term health can be more significant, such as the risk of osteoporosis and weakening of your bones. Symptoms do not appear gradually, as with spontaneous menopause, but suddenly and abruptly, or over a relatively short time.
It’s important to understand that the impact of induced menopause is even greater because you have a complete reduction in hormone levels, estrogen, and androgens, and not a gradual decline. During breast cancer treatment, the addition of anti-estrogen medications, like Tamoxifen, can further amplify symptoms. Dealing with menopause can be even more challenging when you are coping with cancer treatment at the same time.
What are symptoms like for premenopausal women?
Induced menopause symptoms can be more intense for those who are premenopausal.
I am postmenopause, will I get symptoms?
You can go through spontaneous menopause, be diagnosed with cancer, have your ovaries removed (for example during a hysterectomy for ovarian cancer), and begin to have hot flashes again. This is because estrogen can still be produced by your adrenal glands and fat cells, but the anti-estrogen medication or chemotherapy blocks this, resulting in menopause-like symptoms.
What’s the psychological impact of induced menopause?
For those with a cancer diagnosis, it can be a shock to deal with cancer and then face the symptoms of induced menopause. The combined impact of cancer, the stress of diagnosis and treatment, and then unexpected menopause is a massive thing to deal with. You may find recovery complex, with low mood and libido.
You can feel you are aging quicker than you should be. You may not feel the same emotions you used to feel. You may be concerned about body image, particularly if you’ve had a mastectomy or hysterectomy. It may not be visible but is a huge part of who you are.
One woman shared, ‘You get hit with a cancer diagnosis and then the menopause comes along. The two are equally big but you get cancer support. I am incredibly grateful that my cancer has gone but I now have to deal with menopause, something that I would not normally be dealing with at my time of life.’
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How can you manage induced or surgical menopause symptoms?
There’s a wide range of experiences with induced menopause due to cancer and cancer treatment. For example, the majority of cervical cancers are not estrogen sensitive and it is recommended that HT is offered at least up to age 50 for those experiencing surgical menopause before that age.
People with estrogen and progesterone-sensitive tumors, such as many breast cancers, will be given treatments that help prevent the recurrence of estrogen-sensitive cancers.
- Tamoxifen and raloxifene (Evista) block either the production or the uptake of estrogen
- Anastrozole (Arimidex), exemestane (Aromasin) and letrozole (Femara) help your body stop making estrogen. These are called aromatase inhibitors and three are approved for breast cancer treatment. Read more
Even for those with a history of breast cancer, vaginal HT is safe in many cases. Any decisions about HT should be made in collaboration with an oncologist if you have a personal cancer history.
If you have just had a cancer diagnosis, will you have to stop taking HT?
You may need to stop your HT if your cancer is estrogen or progesterone sensitive. If you need to stop taking HT, you may experience a sudden onset of menopause symptoms that can be challenging. There are non-hormonal options to help you.
Talk to your oncologist about what treatments are suitable for you. You can request a referral to a specialist to discuss managing induced menopause.
Taking care of yourself can be challenging when undergoing treatment and you don’t feel well and your energy is low. Managing stress levels, keeping active, trying to sleep regular hours, and eating well can help many menopause symptoms, from hot flashes to sleep issues and weight gain to low mood. Any small changes can make a big difference.
Talk to your healthcare provider about what treatments are available for vaginal dryness, which can lead to painful sex and urinary tract infections (UTIs). There are many products available that may help.
Talk to your healthcare provider about treatment to manage menopause symptoms if you are unable to take HT. Some antidepressants and blood pressure medicines can help reduce the severity of hot flashes.
Talk to your healthcare provider before taking anything, as supplements may interfere with your treatment, particularly if you have a cancer diagnosis. Read more about supplements.
What does an induced menopause mean for your fertility?
Loss of fertility, whether you want children or have completed your family, is still a massive issue because the choice is being taken away from you.
There are some types of chemotherapy and radiation treatments as well as surgeries that remove the ovaries that may prevent you from becoming pregnant again and may cause you to enter menopause suddenly. For example, cervical cancer treatment can involve local radiotherapy to your pelvis and cause infertility due to the treatment.
Sometimes, you can have eggs preserved outside your body before cancer treatment starts. This means there is a delay in starting cancer treatment so this can often be a tough decision to make.
When is the right time for induced menopause support?
I often get asked when is the best time to get menopause support. There is no right time, it’s when it feels right.
Recovery from cancer treatment can take more time than expected and 75% of people will have fatigue for two years post-treatment. This is when psychological distress may hit.
There must be a discussion early on in diagnosis about the impact of treatments on menopause and long-term health. You need to understand the importance of bone health and cholesterol levels. It’s not just about managing menopause symptoms but managing the physiological changes to your body.