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Treatment-induced menopause

Menopause is the time in a woman’s life when her ovaries stop making estrogen and she has not had a menstrual period for 12 months. Most women start menopause naturally between 45 and 55 years of age. Some cancer treatments cause menopause to occur earlier. This is called treatment-induced menopause.

Causes

Treatment-induced menopause can be caused by:

  • surgical removal of both ovaries
  • chemotherapy
  • radiation therapy to the pelvis
  • hormonal therapy

If both ovaries are removed, a woman goes into treatment-induced menopause that is permanent.

A woman’s age is the most important factor that determines whether or not chemotherapy will cause treatment-induced menopause. It is more often permanent in women who are within a few years of natural menopause. It may not be permanent in younger women. Other factors that influence whether or not chemotherapy can lead to treatment-induced menopause include the type of drug, the dose of the drug and the length of treatment.

The effect of radiation therapy on the ovaries may be temporary or permanent. This depends on the woman’s age and the dose of radiation.

Some hormonal therapies can cause menopausal symptoms, such as changes in menstruation and hot flashes. Others can cause treatment-induced menopause.

Symptoms

Symptoms of treatment-induced menopause can vary in severity. Each woman experiences menopause differently. The symptoms of treatment-induced menopause are the same as natural menopause. They include:

  • hot flashes
  • night sweats
  • irregular or no menstrual periods
  • problems sleeping such as not being able to fall asleep, or insomnia
  • vaginal dryness, itching, irritation or discharge
  • loss of interest in sex
  • painful intercourse
  • bladder or vaginal infections
  • mood swings or irritability
  • weight gain
  • depression

After menopause, women are at risk of losing bone mass or density, which can lead to osteoporosis. Women who have entered menopause also have a greater risk of heart disease.

Diagnosis

Treatment-induced menopause is usually diagnosed by:

  • physical exam
  • questions about your symptoms
  • blood tests to measure hormone levels

Managing symptoms of menopause

Talk to your healthcare team about your symptoms. They can suggest ways to manage them. You can also try the following measures.

Maintain good general health

Be active. Try different activities such as walking, bike riding or other types of exercise.

You can help avoid bladder and vaginal infections by drinking lots of fluids and emptying your bladder often. Wear cotton underwear that breathes and keep the genital area clean.

Try relaxation techniques, such as visualization, deep breathing, massage or yoga to improve your mood and help you with sleep problems.

Take measures to be comfortable

If you have hot flashes, wear light clothing and dress in layers. Try splashing cool water on your wrists.

There are different measures you can try if you have sexual problems such as vaginal dryness or painful intercourse. Use a water-based lubricant to make sex more comfortable. Try practising Kegel exercises to strengthen your pelvic floor muscles. These exercises also help the muscles relax.

Talk to your healthcare team about medicines

Medicines that were designed to treat other health problems can sometimes help with hot flashes. Your healthcare team may suggest:

  • clonidine (Dixarit, Catapres), which treats high blood pressure
  • an antidepressant medicine, such as venlafaxine (Effexor), paroxetine (Paxil) or fluoxetine (Prozac)
  • antiseizure medicines, such as gabapentin (Neurontin)

This doesn’t mean that you have high blood pressure, are depressed or are having seizures. It’s not uncommon for medicines to be used for different purposes.

Your healthcare team may also suggest vitamin E supplements to help with hot flashes.

Hormone replacement therapy (HRT) may be prescribed if your type of cancer isn't affected by hormones. HRT has both risks and benefits. Talk to your doctor about how it might be used to treat hot flashes.

Other remedies

Some women may want to try herbal therapies to relieve symptoms of menopause. There isn’t enough research to show that these remedies are safe or effective. Some herbal therapies can also interfere with treatments or may be harmful. Always check with your doctor before taking any herbal products.

Soy products contain weak plant estrogens called phytoestrogens. Some people think that phytoestrogens from soy products can help with symptoms of menopause. It is not known what effect phytoestrogens have in women with hormone-related cancers such as breast or ovarian cancer.

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