It’s no secret that cancer treatments often come with unwanted side effects. In the case of breast cancer and cancers of the reproductive tract, that can mean getting launched into early menopause in your 20s, 30s or 40s, even if you hadn’t been experiencing symptoms of perimenopause or menopause before starting therapy.
“The purpose of many of these treatments for reproductive cancers is to literally deplete the body of as much estrogen as possible in an effort to prevent the cancer from re-growing once it’s been removed,” explains Bonafide Chief Medical Officer Dr. Alyssa Dweck.
Here, we talk more with Dr. Dweck to learn about the cancers and therapies that can trigger early menopause, whether chemo- or treatment-induced menopause is always permanent, the symptoms that can occur, and how women who have or have had cancer can manage them safely.
Which cancer therapies can cause early menopause?
Both surgical procedures and additional therapies to treat cancer can cause symptoms of early menopause, Dr. Dweck explains.
“Surgical treatments, including the removal of ovaries for ovarian or breast cancer treatment or as a preventive measure will result in immediate menopause since ovarian estrogen production is instantly ceased,” she says. Surgically induced menopause is notable because it happens instantaneously, compared to the natural process, which happens much more gradually over many years. “The symptoms are very noticeable because they’re sudden,” says Dr. Dweck.
Women can also experience chemotherapy-induced menopause, which can start quickly. “I’ve had several women in their 40s who undergo breast cancer treatment with chemotherapy, but their ovaries are still intact. They start treatment and their periods stop shortly thereafter,” says Dr. Dweck. “Some of the additional therapy like aromatase inhibitors or tamoxifen can give women symptoms of menopause because they deplete the body of estrogen.” Like surgery-induced menopause, these symptoms can start suddenly and feel intense.
It’s possible to go through radiation-induced menopause too. “Some cancers require radiation therapy, which might include pelvic radiation. This might damage the ovaries, causing them to stop producing estrogen,” Dr. Dweck explains.
Can premature menopause be reversed?
In some cases, yes. While chemo-induced menopause can sometimes be permanent, in other cases, it’s temporary, particularly for many younger women with breast cancer. “During a first or second chemo cycle, some women lose their periods for more than a year’s time which is diagnostic of menopause” Dr. Dweck explains.
But as the time passes, it is not uncommon to see the unexpected return of menses. “This gets tricky because women may need to consider contraception again. There are many of nuances with this,” says Dr. Dweck.
It’s important to note that temporary, chemo-induced menopause is different from surgical menopause that comes from having the ovaries removed. “When the ovaries are removed, hormones like estrogen are no longer being produced in the ovaries,” says Dr. Dweck. In other words, menopause is permanent.
That said, not all reproductive surgeries for cancer trigger immediate menopause. In many cases of cervical cancer, the uterus and cervix are removed while the ovaries are left intact. “This can cause a woman to stop having periods but, since the ovaries are still producing estrogen, hormone levels remain in the premenopausal range,” says Dr. Dweck.
These women will go through menopause naturally when their ovaries eventually shut down and stop making estrogen. But without a monthly period, it can be more difficult to diagnose menopause, Dr. Dweck explains. “Sometimes we have to check hormone levels and bloodwork to really support the diagnosis,” she says.
What are the symptoms of early menopause after undergoing cancer treatment?
A woman’s individual symptoms can depend on the type of treatment she has. “But hot flashes and night sweats as well as vaginal dryness can be overwhelming for these women,” says Dr. Dweck.
Are there treatments for premature menopause, or strategies for managing the symptoms?
Healthy lifestyle habits like eating right, exercising, managing stress, and getting enough sleep can help women feel better overall, whether they’re dealing with cancer-induced menopause symptoms or menopause that’s naturally occurring, Dr. Dweck says.
Certain treatments can help manage specific symptoms as well, but in general, vaginal estrogen therapy is not first line for women who have had hormone-positive cancers, says Dr. Dweck. “Systemic hormones are contraindicated (meaning, they shouldn’t be used) in this population because many of these cancers are hormone-sensitive. The estrogen could potentially start a recurrence of cancer cell growth,” she explains.
Thankfully, safe and effective alternatives exist. “Hormone-free products can alleviate certain menopause symptoms. For example, Bonafide’s Revaree® can be used to relieve vaginal dryness, she says. For pain during sex, dilator therapy can also be helpful, she notes.
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Revaree® is a hormone-free treatment option for vaginal atrophy and associated symptoms of dryness, burning, irritation and painful sex. .
Keep the lines of communication open with your care team – including your oncologist, gynecologist, and internist –and be open about how you’re feeling, too. “Cancer care involves a team approach these days,” Dr. Dweck says. “Decisions about managing symptoms can be made jointly and on an individual basis.”
Finally, head into treatment with the knowledge that these changes can occur – and try to prepare mentally and emotionally. “Prioritizing your mental health is so important,” Dr. Dweck says. “Relationships can change because women often feel less feminine, and their partners temporarily assume the role of caregivers. Relationships have to be recalibrated so a new normal is established,” she explains.
During this time of change, Dr. Dweck recommends doing what you can to prioritize intimacy with your partner. Working with a trained counselor or therapist can help you learn new communication techniques, as well as structured sexual exercises like sensate focus (a sex therapy technique that focuses on sensory perceptions) and massage. “Intimacy is so important; so, try to set limitations on other commitments and responsibilities,” she says.