Menopause is the natural end of your body's ability to become pregnant and have a child. Perimenopause is the time leading up to your last menstrual cycle and may begin in your 40s and can last several years. Your body begins to make less and less of the hormones needed for your menstrual cycle. Your ovaries stop releasing eggs and menstrual periods change and eventually stop. Menopause happens when you have not had a period for 12 months.
Some cancer treatments can cause early or sudden menopause. If this happens, talk with your health care team about treatments to help your body adjust.
What cancer treatments can cause menopause?
Treatments that can cause menopause include:
Surgery to take out your ovaries
Chemotherapy, which may damage the ovaries
Hormone treatments or anti-estrogen treatments that keep your ovaries from producing estrogen
Radiation therapy near your pelvis or lower belly
Ask your health care team if your cancer treatment could cause menopause. If so, you may still be able to have children in the future if you want them. Talk with your health care provider about fertility concerns and preservation, before cancer treatment begins.
How do I know if I might be going through menopause after cancer treatment?
You might be going through menopause if you notice some of these changes:
Hot flashes. Your face, chest, and other areas might suddenly get very hot and sweaty. You might feel your face getting red. Hot flashes usually last just a few minutes.
Night sweats. You might wake up soaked in sweat.
Genital and urinary problems. These can include vaginal and vulvar dryness, itching or irritation, painful sex, urinary frequency or urgency, urinary leaks, and more frequent urinary tract infections.
Vaginal problems. These can include dryness, painful sex, itching, irritation, and fluid (discharge) from your vagina.
Bladder problems. You might leak urine, need to go more often than usual, or have trouble waiting until you can get to a bathroom. You might also get urinary tract infections.
Mood changes. These can include feeling depressed, irritable, or anxious. You might also have mood swings.
Sleep problems. The other symptoms of menopause can make sleeping difficult. Depression and anxiety related to menopause may also cause sleeplessness.
Hot flashes and vaginal dryness are more likely with chemotherapy, tamoxifen, and certain other medicines. These include anastrozole (Arimidex), exemestane (Aromasin), and letrozole (Femara).
Menopause is also linked with osteoporosis. This is a condition in which your bones are thinner and more likely to break. You may not have symptoms, so you might not know until you break a bone. Your health care provider may check you for this condition if your cancer treatment could cause it.
Coping with menopause from cancer treatment
There are many treatments for menopause caused by cancer treatment. If you experience any symptoms of menopause during your cancer care, talk with your health care team. You can also talk with a doctor or other health care provider who specializes in women's health.
You may need to continue your menopause treatment after your periods stop. About 1 in every 3 women has menopause symptoms for 10 years or more. But you do not have to just live with your symptoms. You can try different treatments if you need to.
Here are some ways to cope with specific menopause symptoms.
Hot flashes. Hot flashes are caused by hormonal changes in your body. There are prescription hormonal and non-hormonal medications you can take to help with hot flashes. Other treatments include:
A type of counseling called "cognitive behavioral therapy" that help manage anxiety and depression, which make hot flashes worse
Thinner bones (osteoporosis). You might need an X-ray called a bone density test. This test measures how thick your bones are in certain places, usually your hips and spine. This tells your health care provider if your cancer treatment is making your bones thinner. If so, you can do the following things:
Do exercises where you support your own body weight, such as walking for 20 to 30 minutes each day. Ask your health care provider what exercises you should do.
Maintain a healthy weight.
Take calcium, vitamin D, or both. Your provider may do a blood test to check if you have enough vitamin D in your blood. If not, they can tell you how much to take.
Take medicine to help make your bones stronger.
Changes to your vulva, vagina, and bladder. There are several different ways to treat a dry or sensitive vulva and vagina. These treatments can also help with bladder problems such as urinary frequency and urgency. Treatments include:
Estrogen that you put in your vagina. It comes in different forms, such as a cream, pill, gel cap, or ring.
A medicine called DHEA that you put in your vagina.
A medicine called ospemifene (Osphena) that you take by mouth.
Some of these treatments include hormones, and some do not. If you have certain cancers, hormones might not be safe for you. For example, you might not be able to take systemic estrogen if you have estrogen-receptor-positive breast cancer. Your health care provider can help you find the best option. You might need to try several treatments before you find the right one.
Are there treatments for menopause that do not use hormones?
If you cannot take hormones safely or if you do not want to take hormones, there are other medications you can take to cope with menopause symptoms. If you feel depressed, irritable, or anxious, your doctor may prescribe fluoxetine (Prozac), venlafaxine (Effexor), and others. These can also help with hot flashes. Gabapentin (Gralise, Neurontin) can help with hot flashes and sleep problems. Oxybutynin (Ditropan) can help with hot flashes as well as overactive bladder symptoms.
What hormonal treatments are available for menopause?
Estrogen is the main hormone used to relieve menopause symptoms. Estrogen can be taken as a pill, patch, spray, gel, or a small ring that you place inside your vagina. Some menopause symptoms occur because your body is making less estrogen. Taking estrogen can help relieve these symptoms. It also helps with thinning bones, or osteoporosis.
Doctors call these treatments menopausal hormone therapy, or MHT. Hormone replacement therapy (HRT) is another name. It can be effective, but some kinds of HRT can also raise your risk of certain conditions. Your provider will probably prescribe just enough dosage to help your symptoms.
If you still have your uterus, your treatment should also include a hormone called progestogen. This keeps the lining of the uterus from growing too much.
The risks and benefits of hormone therapy are different for everyone. Ask your provider if hormone therapy is right for you. You might be able to get non-hormone treatment for specific symptoms instead. Talking with your cancer specialist and your primary care provider can help you find the best options for treating menopause symptoms and discomfort.
Questions to ask your health care team
Could my cancer treatment cause early or sudden menopause?
Should I speak with a fertility specialist before beginning cancer treatment?
Could my cancer treatment affect my sex life? How, and for how long?
What signs of menopause should I look out for?
What are the treatment options for my menopause symptom(s)?
Do you recommend hormone replacement therapy for me?
Long-Term Side Effects of Cancer Treatment
Sexual Health and Cancer Treatment: Women
Fertility Concerns and Preservation for Women
North American Menopause Society