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.

Causes

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

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.

Diagnosis

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

Managing treatment-induced menopause

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

Tips for managing symptoms

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.

Tips for protecting your bones and heart

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

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, 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.

Check with your healthcare team about herbal therapies

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.

Expert review and references

  • Tien Le, MD, FRCSC, DABOG
  • American Institute for Cancer Research, World Cancer Research Fund. Continuous Update Project Report: Diet, Nutrition, Physical Activity and Liver Cancer. 2018: https://www.wcrf.org/dietandcancer/liver-cancer/.
  • British Columbia Cancer Agency. Menopause. 2020: http://www.bccancer.bc.ca/.
  • OncoLink. Menopause Caused by Cancer Treatment. 2020 : https://www.oncolink.org/.
  • My Health Alberta. Menopause and Perimenopause. 2021: https://myhealth.alberta.ca/.
  • Cleveland Clinic. Premature and Early Menopause. http://chemocare.com/. Tuesday, January 11, 2022.
  • American Society of Clinical Oncology (ASCO) . Menopause and Cancer Risk . 2019 : https://www.cancer.net/.
  • US National Library of Medicine. MedlinePlus Medical Encyclopedia: Cancer Treatment: Early Menopause. 2020: https://medlineplus.gov/encyclopedia.html.
  • American Society of Clinical Oncology (ASCO) . Menopausal Symptoms Due to Cancer Treatment . 2020 : https://www.cancer.net/.
  • American Cancer Society. Menopausal Hormone Therapy and Cancer Risk. 2015: https://www.cancer.org/.
  • Chi F, Wu R, Zeng YC, Xing R, Liu Y, Xu ZG . Post-diagnosis soy food intake and breast cancer survival: a meta-analysis of cohort studies. Asian Pacific Journal of Cancer Prevention. 2013.
  • Haas ML . Radiation therapy: toxicities and management. Yarbro, CH, Wujcki D, & Holmes Gobel B. (eds.). Cancer Nursing: Principles and Practice. 7th ed. Sudbury, MA: Jones and Bartlett; 2011: 14: 312-351.
  • Landier W, Smith S . Late effects of cancer treatment. Yarbro, CH, Wujcki D, & Holmes Gobel B. (eds.). Cancer Nursing: Principles and Practice. 7th ed. Sudbury, MA: Jones and Bartlett; 2011: 71: pp. 1756-1779.
  • Moore, S . Menopausal symptoms. Yarbro, C. H., Frogge, M. H. & Goodman, M. Cancer Symptom Management. 3rd ed. Sudbury: Jones and Bartlett Publishers; 2004: 30: pp. 571-595.
  • Nechuta SJ, Caan BJ, Chen WY, Lu W, Chen Z, Kwan ML, Flatt SW, et al . Soy food intake after diagnosis of breast cancer and survival: an in-depth analysis of combined evidence from cohort studies of US and Chinese women. American Journal of Clinical Nutrition. 2012.
  • Wenzel L, Penson R, Carter J, et al . Quality of life issues in gynecologic oncology. Barakat RR, Markman M & Randall ME. Principles and Practice of Gynecologic Oncology. 5th ed. Philadelphia: Wolters Kluwer Health / Lippincott Williams & Wilkins; 2009: 34: pp. 1019 - 1027.