This article was originally published on The Mighty.
For most people who get periods, menopause may seem like a far-off cloud on the horizon — an unpleasant experience we all know we’ll go through someday, but until then, it’s easier not to think too hard about it.
Menopause is the term for the time when your body starts producing less estrogen, which causes you to stop menstruating. It usually starts in your 40s or 50s. If you have an illness that affects your reproductive organs, however, your treatment might cause menopause earlier than normal. This process is called medication-induced menopause (or treatment-induced menopause), and it can be a confusing, frustrating experience, made more difficult by the fact that it piggybacks on top of your other medical issues.
There are a few ways medical treatment could induce menopause. One way is to have surgery to remove your ovaries, which is called oophorectomy. If both your ovaries are removed, you will enter menopause. Or, you could undergo treatment that prevents your ovaries from working correctly and producing estrogen, thus stopping you from ovulating and having a period.
Some reasons for either of these scenarios could be:
- Oophorectomy to treat cancer, such as ovarian cancer
- Oophorectomy to treat benign ovarian tumors or cysts
- Chemotherapy or radiation to treat cancer, such as breast cancer, uterine cancer and ovarian cancer — these treatments can damage your ovaries and alter your hormone levels, causing your period to stop. This is sometimes referred to as “chemopause.”
- Hormonal treatments — these treatments block the activity of estrogen or block the ovaries’ ability to produce estrogen, to treat conditions like hormone receptor-positive breast cancer, which is stimulated by estrogen or progesterone.
Deciding to undergo treatment-induced menopause can be a scary experience, and fill you with more questions than answers. We spoke to Leena Nathan, an OB/GYN at UCLA, to answer some of the most common questions you might have about surgical or medication-induced menopause.
1. Is medically-induced menopause permanent?
If you have your ovaries removed via surgery, you will permanently be in menopause. However, if chemotherapy or radiation or other treatment puts you in early menopause, once you stop that treatment your menopause may actually end. Nathan said it’s difficult to predict exactly which patients might stay in menopause and which don’t.
“I’ve definitely seen patients, especially breast cancer patients who undergo chemo, kind of go through a menopausal phase, and then their period does come back,” Nathan said.
2. What are the long-term health risks associated with medically-induced menopause?
Without estrogen in your system, you may experience a few different long-term side effects. One is decreased bone health. Estrogen helps promote bone growth and health, so without ovaries to produce estrogen, you may develop osteoporosis (reduced density and strength of bones). Another potential side effect is heart disease, since estrogen may play a role in keeping arteries and blood vessels flexible.
Because of these long-term health issues, and the unpleasant side effects of menopause itself, the decision to undergo medically-induced menopause should not be taken lightly. Before treatment begins, you should talk with your doctor about how necessary it is and if there are other options you can try instead.
“There are very few conditions where we would really want to put a patient into menopause long-term,” Nathan said.
3. How will treatment-induced menopause affect my fertility?
Another long-term side effect of menopause is decreased fertility. As you would expect, if you are permanently in menopause, you are no longer ovulating, so you cannot get pregnant naturally. Even if your menopause turns out to be temporary, you may have decreased fertility.
If you want to get pregnant in the future, talk with your doctor before treatment starts about what you can do to preserve your fertility. This may include freezing your eggs or using a donor egg and then using in vitro fertilization or surrogacy to carry the fertilized egg to term.
4. Is medically-induced menopause a cure for endometriosis?
Endometriosis is a painful chronic condition caused when tissue similar to the lining of the uterus is found outside the uterus, such as on the fallopian tubes or colon. Surgery to remove the ovaries and/or uterus (removal of the uterus is called a hysterectomy) may be suggested as a possible treatment for endometriosis. However, neither of these procedures are a guaranteed cure. Hysterectomy will stop you from getting a period, but if you still have your ovaries, you will not go through menopause. Your endometriosis could still come back even if you don’t have a uterus or ovaries.
“If we’re doing something to shut down a woman’s ovaries for endometriosis, it’s usually just temporary to try to stabilize the disease, and then figure out a different way to treat it,” Nathan said.
5. Are the symptoms of treatment-induced menopause the same that you would experience with natural menopause?
Unfortunately, you can expect to experience the same symptoms you’ve heard older women going through menopause talk about. Even though your menopause is medically-induced, you are still experiencing the same hormone drops that other women in menopause are experiencing. These symptoms can include:
- Hot flashes, redness and sweating
- Irritability and mood changes
- Weight gain
- Irregular periods
- Vaginal dryness
6. How can I cope with the symptoms of menopause?
Menopause symptoms can last for years, and as any of your older relatives can tell you — they’re notoriously challenging. But there are a few strategies you can try while you ride it out.
Nathan said the most effective way to treat hot flashes is through hormone replacement therapy, which is medication that gives back some of the hormones that decrease during menopause, such as estrogen and/or progesterone. Another option is the SSRI class of antidepressants — some of these medications may help with hot flashes. Herbal remedies such as black cohosh and soy isoflavones can also mimic estrogen.
However, check with your doctor before trying any of these treatments. Depending on your illness, you may not want any extra estrogen — for example, people who have had a type of breast cancer that is stimulated by estrogen should not take more estrogen.
Over-the-counter sleep medications and prescription medications may be considered (with a doctor’s approval), Nathan said. In addition, alleviating hot flashes can also make a big difference in the quality of your sleep.
Exercise and making an effort to reduce your stress can also help with sleep issues and improve mood swings.
One thing to consider is a topical form of estrogen that is applied directly to the vaginal tissue. Again, if you are actively treating breast cancer and cannot take extra estrogen, this method isn’t for you. Another option is using lubricants or even natural products like coconut oil.
Irregular periods are tough to manage — it’s common during menopause to skip periods and not know when the next one is coming. Nathan said there isn’t much you can do to smooth out irregular periods, but if you don’t want to carry children in the future, one potential option is endometrial ablation. During this procedure, the lining of the uterus is burned off. Nathan said about 60% of women will never have a period after that.
Hormone therapy like estrogen and progesterone can also help control irregular periods, but again, if your condition could worsen by taking hormones, this won’t be an option.
7. How can I cope with the stress and uncertainty of treatment-induced menopause?
Menopause is a challenging time for anyone, so having a support system is crucial. Find people who give you a shoulder to cry on, help you laugh through the most ridiculous hot flashes, and remind you that you’re still you, even though you’re going through “the change.”
“All I know is that you have to find the crew that will rally around you when sh*t gets thick,” Abby W. told The Mighty.