Medically induced menopause

This may depend on the treatment or surgery that causes the menopause, as well as your individual situation.

Medically induced menopause often happens faster than natural menopause. This is because in natural menopause, you go through perimenopause. This is when female hormone levels change, but you still have periods. For some women, perimenopause can last for years.

With medically induced menopause, you don’t always experience perimenopause.

Research suggests that:

• if you have both ovaries removed, menopause happens straight away
• chemotherapy may trigger menopausal symptoms straight away or months after treatment
• radiation therapy may cause medically induced menopause about 3 months after treatment, depending on the dose and treatment area of your body
• hormone injections to treat conditions such as endometriosis or fibroids can take a few weeks to induce menopause.
• a hysterectomy without ovary removal may lead to earlier menopause.

Medically induced menopause can be worse than natural menopause for different reasons.

Symptoms can come on suddenly

This can make the experience more intense and feel like more of a shock.

Some symptoms can be more severe

After ovary removal, the sudden drop in oestrogen can make some symptoms more intense. This includes:

• reduced sex drive (libido)
• severe sleep problems.

Women who experience menopause due to breast cancer treatment can have more severe symptoms. For example:

• dry vagina
• painful sex
• urinary tract infections (UTIs).

They may also be more likely to experience depression and anxiety.

Emotional distress

Medically induced menopause can be distressing, especially if you’re coming to terms with an unexpected loss of fertility, or dealing with a diagnosis of cancer.

Just as natural menopause increases some risks of health conditions, so does medically induced menopause.

You may have a higher risk if you reach menopause before the normal age range, but we need more research to understand this.

Risks might include:

• cardiovascular disease – increased risk of high cholesterol and blood pressure
• bone health – increased risk of osteoporosis
• cognitive health – increased risk of memory problems.

You can reduce your risks with a healthy lifestyle, for example, a healthy diet and regular exercise.

Menopausal hormone therapy (MHT) and other medicines may also help. Ask your doctor about the risks and benefits before making a decision.

Treatment for certain cancers are more likely to bring on medically induced menopause. For example:

• breast cancer
• ovarian cancer
• vaginal cancer
• uterine cancer
• cervical cancer.

Treatment for other cancers can also bring on menopause.

Does chemotherapy cause menopause?

Certain chemotherapy drugs can damage the ovaries, which may lead to medically induced menopause.

Chemotherapy works by targeting and killing cells that divide quickly. This includes cancer cells, but may also affect cells in your ovaries.

Does radiation therapy cause menopause?

Some types of radiation therapy are more likely to affect your ovaries. This can cause medically induced menopause.

For example:

• pelvic area radiation therapy – used to treat ovarian, uterine, bladder or bowel cancer
• radiation treatment for the head or brain – this can affect the pituitary gland, which tells your ovaries to make hormones such as oestrogen
• whole body radiation therapy.

Certain hormone medicines used to treat cancers, including some breast cancers, can cause medically induced menopause.

Anti-oestrogen medicines affect the ovaries and usually cause menopausal symptoms. For example:

• tamoxifen
• goserelin
• aromatase inhibitors.

Surgery to reduce your risk of an inherited cancer or to treat cancer may cause menopause.

You will experience menopause if both ovaries are removed in surgery. This might happen if you have:

• ovarian cancer with a strong family history
• gene mutations such as BRCA1, BRCA2 or Lynch Syndrome
• and sometimes it’s recommended for breast cancer treatment.

If you have severe endometriosis, you might need surgery or hormone injections to stop your ovaries from producing hormones that make endometriosis worse. These can cause medically induced menopause.

As with endometriosis, you might need surgery or hormone injections to treat adenomyosis. These can cause medically induced menopause.

If you have fibroids, you might need hormone injections that stop your ovaries from producing hormones that encourage fibroid growth. This can cause medically induced menopause.

Some women need to have a procedure called a uterine embolisation, which cuts off the blood supply to fibroids. This procedure can cause medically induced menopause, but we need more research to understand this.

Hormone injections may help with severe mood changes that are associated with premenstrual dysphoric disorder (PMDD). These are only recommended when other treatments haven’t worked. The hormone injections can cause medically induced menopause.

If you have large or painful cysts, you might need surgery to remove the cysts and one or both ovaries or the fallopian tubes. This can cause medically induced menopause.

Your doctor may recommend a hysterectomy if you have a health condition and other treatments haven’t worked.

A hysterectomy is an operation to remove your uterus (womb) and sometimes your ovaries or fallopian tubes.

If your uterus and both ovaries are removed, it will cause medically induced menopause.

If you still have one or both ovaries, you might:

• have a natural menopause – but it may happen earlier than the normal age range
• have medically induced menopause.

Your doctor will usually recommend menopausal hormone therapy (MHT) if you’re under the age of 45 when you experience medically induced menopause – unless you’ve had a hormonal cancer diagnosis.

Depending on your situation, your doctor will recommend different types of MHT.

Vaginal oestrogen can help with:

• vaginal dryness and itching
• painful sex
• urinary issues, like needing to wee more often or urgently.

This treatment may be prescribed after breast cancer, depending on your circumstances.

Non-hormone treatments are also available to help with symptoms such as hot flushes and night sweats.

A healthy lifestyle, including a healthy diet and regular exercise, can help you manage menopausal symptoms.

It can also help with your overall health, including:

• bone health
• heart health
• brain health.