Treatment-induced menopause

Menopause is when the ovaries stop making estrogen and you have not had a menstrual period for at least 12 months. Menopause usually happens around 50 years of age. Some cancer treatments cause menopause to occur earlier. This is called treatment-induced menopause.

Treatment-induced menopause can be caused by:

• surgery to remove both ovaries
• chemotherapy
• radiation therapy to the pelvis
• hormone suppressive therapy

Surgery to remove both ovaries causes acute, permanent treatment-induced menopause.

Chemotherapy drugs can stop the ovaries from working properly, leading to treatment-induced menopause. This may be temporary or permanent depending on your age, the type of drugs, the dose of drugs and the length of treatment.

Radiation therapy to the ovaries can cause damage to ovaries, leading to treatment-induced menopause. This may be temporary or permanent depending on your age and the dose and location of radiation therapy.

Some hormone suppressive therapies can temporarily stop the ovaries from releasing eggs and cause temporary treatment-induced menopause.

Symptoms of treatment-induced menopause can range from mild to severe. Everyone experiences menopause differently. The symptoms of treatment-induced menopause are the same as natural menopause. They include:

• hot flashes
• night sweats
• fatigue
• irregular or no menstrual periods
• problems sleeping such as not being able to fall asleep, or insomnia
• vaginal dryness, itching, irritation or discharge
• lower sex drive
• painful sex
• difficulty controlling the bladder, leaking urine or having to go pee more often
• bladder, vaginal or urinary tract infections (UTIs)
• mood changes
• weight gain
• depression
• headaches
• heart palpitations

Less estrogen as a result of menopause can also increase your risk for heart disease and osteoporosis.

If you begin to have symptoms of menopause, your healthcare team may diagnose treatment-induced menopause by:

• asking you questions about irregular menstrual periods or other symptoms of menopause
• doing blood tests to measure hormone levels

Treatments for treatment-induced menopause focus on relieving any symptoms and preventing or managing any chronic conditions as a result of menopause.

Talk to your healthcare team about your symptoms. They can suggest ways to manage them.

• Avoid things that can trigger hot flashes such as caffeine, alcohol, spicy foods, tight clothing, stress, hot weather and cigarette smoke. If you have hot flashes, wear light clothing and dress in layers. Try splashing cool water on your wrists.

• Be active and exercise daily.
• Lower stress as much as possible. Try relaxation techniques, such as visualization, deep breathing, massage or yoga to improve your mood.
• Drink lots of water.
• 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. Find out more about managing sexual problems.

• Get a good sleep. Find out more about sleep problems.

Early menopause can increase your risk for osteoporosis and heart disease. Protect your bone and heart health by:

• eating well and getting enough calcium and vitamin D
• moving more and sitting less
• living smoke-free
• talking to your doctor about getting regular tests for bone density, blood pressure, cholesterol and blood sugar levels

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

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

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

Hormone replacement therapy (HRT) may be prescribed if the 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.

You 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 healthcare team before taking any herbal products.

Soy products contain weak plant estrogens called phytoestrogens. Phytoestrogens from soy products may help with symptoms of menopause. Some people with hormone-related cancers, such as breast or ovarian cancer, worry that the phytoestrogens in soy may act like estrogen and will make the cancer grow or come back after treatment. But most of the current evidence suggests that the soy taken in as part of a healthy, balanced diet is unlikely to be harmful.