What Is Medical Menopause?

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Menopause is a natural process that happens gradually over several years. Medical, induced, or surgical menopause is usually a result of treatment for a health condition—such as cancer. It happens much faster than natural menopause and it often causes more severe symptoms.

Induced menopause is when medical treatments, like chemotherapy or surgery, cause a person to stop producing eggs prematurely before menopause would normally occur. The effects can be temporary or permanent, depending on the treatment and the extent of damage to the ovaries.

Read on to find out more about the causes of medical menopause and the treatments available.

Exhausted mature woman entering menopause
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Causes of Medical Menopause

Several procedures and treatments can induce medical menopause. If you're considering any of them, you should discuss this with your healthcare provider ahead of time.

Surgery

Surgical menopause occurs when a person's ovaries are surgically removed (oophorectomy) or after a radical hysterectomy (removal of the uterus, ligaments around the uterus, and the upper 1/3 of the vagina).

These procedures may be done for different reasons, such as:

Without ovaries or a uterus, a person is not fertile and no longer produces estrogen. Surgical menopause is immediate and permanent and is often more symptomatic than natural menopause due to the suddenness of the change.

Radiation

Radiation to the pelvic area, which may be prescribed to treat cancers occurring in that area (such as ovarian, colorectal, or uterine cancers), can damage the ovaries.

This damage can cause a sudden drop in hormone levels, resulting in amenorrhea (stopping of periods) which can be temporary or permanent.

Your odds of recovering your fertility may be lowered by certain factors:

  • Advanced age
  • Radiation treatment close to your ovaries
  • A high total dose of radiation

Pelvic irradiation may also impact uterine function and contribute to a loss of fertility.

Chemotherapy

Chemotherapy works by destroying fast-dividing cancer cells. Because the ovaries contain rapidly-dividing cells, they are also affected by chemo. Depending on how old you are and what types and dosage of medications you receive, your ovaries may or may not recover from this damage.

It is hard to know if your periods will stop temporarily during chemotherapy or for good, and it's not possible to predict how soon you will know the answer. Your healthcare provider will periodically perform blood tests to check your hormone levels.

If you are in your late 40s at the time you go through chemotherapy, your medical menopause may carry you into post-menopause without a recurrence of your menstrual cycle. If you are 30 or younger at the time of treatment, you may resume your periods and experience natural menopause in the future.

Hormone Therapy

The use of medications to temporarily shut down the ovaries in order to suppress the production of estrogen is known as ovarian suppression therapy and may be used as a treatment for hormone receptor-positive breast cancer.

Medications that shut down the ovaries temporarily include Zoladex (goserelin) and Lupron (leuprolide). These are both luteinizing hormone-releasing hormone (LHRH) agonists, and they work by telling the brain to stop the ovaries from making estrogen. The medicines are given as injections once a month over the course of several months or every few months.

Once the medicine is stopped, the ovaries usually begin functioning again. The time it takes for the ovaries to recover can vary from person to person. The younger you are, the more likely it is that your ovaries and estrogen levels will bounce back.

There have been cases of people getting pregnant while on ovarian suppression medications, so if you are premenopausal and have a cis-male partner, it's important to use non-hormonal birth control such as condoms, a diaphragm, or a non-hormonal IUD.

Symptoms

Medical menopause causes the same symptoms as natural menopause, but the symptoms may come on more abruptly than they would with a more gradual, natural transition.

Symptoms and side effects of medical menopause include:

  • Hot flashes
  • Vaginal dryness
  • Vaginal or bladder infections
  • Night sweats
  • Changing libido
  • Memory problems
  • Mood changes
  • Insomnia
  • Infertility
  • Weight gain
  • Aches and pains
  • Headaches
  • Skin and hair changes

Menopause also increases the risk of osteoporosis. During menopause, the bone turnover and buildup cycle are impaired by lower estrogen levels. The bone is broken down, but not as much building occurs. This potentially leads to weaker bones and, for some people, osteoporosis.

Declining estrogen levels have also been associated with cardiovascular risk factor changes that increase the risk of heart disease.

Having your ovaries removed reduces hormone levels literally overnight. For younger people, menopausal symptoms after this surgery can be particularly intense.

Treatment

There are a variety of treatments for menopause. Talk with your healthcare provider about which of these would be most appropriate for you.

They can include:

  • Hormone replacement therapies (HRT): HRTs can be taken orally or via a patch, or they can be placed in the vagina via a cream to help with dryness. HRT is not recommended for people who have had breast cancer, as it has been associated with an increased risk of recurrence.
  • Antidepressants: These medications may help with hot flashes, as well as underlying depression and mood disturbances. Commonly prescribed drugs can include citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft).
  • Over-the-counter lubricants: Lubricants can help with vaginal dryness.
  • Insomnia: Cognitive behavioral therapy, hypnosis, valerian, exercise, isoflavones, and gabapentin have all been recommended as treatments. Before you start treatment, it's important to have a medical evaluation to see if you have any medical conditions affecting your sleep.
  • Complementary and alternative treatments: Acupuncture, cognitive-behavioral therapy, mindfulness-based stress reduction, or hypnosis may help with hot flashes, insomnia, and irritability.
  • Diet and exercise programs: A healthy diet and exercise program can help manage weight gain.

Summary

Menopause can be challenging when it happens naturally, but when it's medically induced, it can be especially so. Emotionally, it can take getting used to, especially if it's abrupt. There are a variety of over-the-counter and prescription treatments that can help with symptoms. Talk to your health care provider about your options.

A Word From Verywell

In addition to the physical changes brought on by induced menopause, the emotional effects can be profound, especially if you are young, no longer fertile, and had hoped to get pregnant in the future. Talk to your healthcare provider, who may be able to refer you to a support group of people going through the same experience.

Frequently Asked Questions

  • Is medically-induced menopause worse than natural menopause?

    Usually, yes. Premenopausal women whose menopause is surgically induced due to removal of the ovaries tend to experience severe effects.


    These include a higher risk of:

    • Overall mortality rate
    • Heart disease
    • Stroke
    • Cognitive impairment
    • Mental health disorders
    • Osteoporosis
    • Sexual dysfunction

    Some treatments cause menopausal-like symptoms, so if you're near menopause or going through it already, it can increase the symptoms.

  • How long does medically-induced menopause last?

    It depends. Some chemotherapies or hormone treatments cause cessation of menstrual periods during treatment, and for some women, their periods may return at some point after treatment ends. For other women, it may be permanent. It can depend on whether you are close to menopause or not, the dosages of the drug, and how much damage was done to the ovaries.

  • Can medically-induced menopause be reversed?

    It depends. If the menopause is surgically induced because the ovaries were removed, no, it cannot be reversed. Certain types of chemotherapy or hormone therapy—for breast cancer, for example—can cause medically-induced menopause. This may be temporary or permanent.

Originally written by
Pam Stephan
Pam Stephan is a breast cancer survivor.
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