Hot flashes from head to toe, achy joint pains, tossing and turning from insomnia, and highly unpredictable periods: menopause symptoms you thought were decades away can come as a shock, especially at a younger age.
Treatment-induced menopause can manifest in a few different ways. This experience can feel distressing and surprising, especially as treatment-induced menopause sometimes isn’t often mentioned. Below, gynecologists and members of the Jadey community share what to expect and offer some advice about how to talk to your doctor about it.
What Is Treatment-Induced Menopause?
Some cancer treatments can interrupt the ovaries’ normal functioning, causing changes in your periods and menopausal-like symptoms. This is called treatment-induced menopause.
A few different treatments can cause this. Some forms of chemotherapy can affect ovarian function and cause treatment-induced menopause. Radiation to the pelvic region can also interfere with your ovaries. Some estrogen-responsive cancers like certain breast, ovarian, and uterine cancers require hormone therapy, pause or shut down the menstrual cycle for the duration that people are taking them, which can cause people to experience menopausal symptoms due to low estrogen. Surgical treatments that require removal of one or both your ovaries may cause permanent treatment-induced menopause. For targeted therapies and immunotherapy, unfortunately, doctors currently don’t know as much about relation to treatment-induced menopause. And there may also be situations where your medical team will induce you into temporary menopause as a strategy for fertility preservation or to prevent additional blood loss if your blood cell counts are already low.
“I think that this is something that is often glossed over in the very, very long list of potential side effects of cancer treatments, and I think that what women can experience can vary,” says Dr. Suneeta Senapati, a reproductive endocrinology specialist at Penn Medicine.
It's very different knowing that your peers are not going through what you are.
There are so many variables to what determines your potential treatment-induced menopause experience, which is why it’s important to ask your doctor about how your profile and treatment plan come into play. Oftentimes, period changes during treatment are common, and not necessarily treatment-induced menopause (read our piece about periods during cancer treatment here). In these instances, your symptoms may go away and your period will return after treatment, especially if you were younger than 40 at the start of treatment.
“For those who stop cycling with chemo, we usually say that it can take up to a year for someone’s menstrual cycle to come back to their normal,” Dr. Senapati says. “Some may resume cycles much sooner than that.”
Many people experience resumption of periods and end of menopausal symptoms following treatment. However, if you were already approaching menopause at the time of your diagnosis, cancer treatment may put you in complete menopause soon or immediately after completing treatment. And even if your periods resume after chemo, some chemotherapy treatments can cause early menopause further down the line. Hormone treatment- and radiation-induced menopause may or may not lead to permanent menopause, and menopause due to surgical ovarian removal is permanent. These can be upsetting outcomes, of course, and the fact that many doctors won’t mention them can make them shocking as well.
What About Fertility?
Because treatment-induced menopause involves your reproductive system, there can be long-term effects to your fertility. For example, surgical procedures may remove your ovaries altogether, while radiation or chemo can damage your follicles, the sacks of cells that eventually release mature eggs that can be fertilized. There are so many factors that go into predicting the effects of your treatments on your fertility, and we know this can be overwhelming, saddening, and confusing.
What Are the Side Effects?
The side effects of treatment-induced menopause are similar to the classical menopausal symptoms due to hormonal changes, such as irregular or skipped periods, hot flashes, mood changes, anxiety, brain fog, vaginal dryness, difficulty sleeping, weight gain, and low sex drive. The difference is, they can come on much faster.
Cooling Off Hot Flashes
Many women are caught off guard by the intensity of their symptoms, especially hot flashes.
“The thing that I experienced immediately, that I thought was a joke if I'm being honest, is I got hot flashes,” says Dani Trops, who was diagnosed with breast cancer when she was 30. “It’s like all of a sudden your body is on fire.” For her treatment, Dani was put into induced menopause before starting chemotherapy to potentially preserve her fertility.
“I was experiencing about 20 to 30 hot flashes a day. I would literally be in the street and have to strip off,” says Rachel, who was diagnosed with breast cancer when she was 46. Before cancer, Rachel had already been experiencing some perimenopausal symptoms and was on hormone therapy to alleviate them. Her breast cancer diagnosis was hormone positive, requiring her to come off the hormone therapy. She says she started experiencing these hot flashes upon starting chemotherapy following her mastectomy, and again when she was put on a hormone treatment after a recurrence.
To manage hot flashes, Rachel says her doctor suggested ending showers with cold water and avoiding alcohol and spicy foods. “Layers were my best friend,” Dani says, suggesting dressing in multiple shirts or sweaters so you can adjust your outfit’s warmth to your hot flashes.
Bone Health and Heart Health Concerns
Going into menopause early can weaken both your cardiovascular system and your bones. If you remain menopausal after treatment, and don't have a hormone-responsive cancer, you and your medical team can discuss how hormone replacement therapy can lower these risks for you. And if you did have a hormone-sensitive cancer, your oncologist should be monitoring you for these concerns, and you might consider regular bone scans.
Was I making this up? Was this just me being in my head?
Nursing Joint Aches and Muscle Pains
Whether it be discomfort during your favorite workout or while resting in bed, prolonged joint and muscle pains can take a toll. These sensations are common and come as a result of lower estrogen levels.
“I would feel like an old lady. It would take me about five minutes to straighten my body and shuffle around until I could actually move properly again.” Rachel says her doctor recommended yoga to ease the pain. Dani also purchased this cooling organic mattress, which she says has helped with her joint pain, hot flashes, and insomnia.
Lisa Massa, a physical therapist at Duke Cancer center who specializes in oncology rehabilitation and women’s health, says that muscle pain is directly related to bodily changes during menopause, specifically the decrease in estrogen. “One of the changes that happens as we become postmenopausal is the skeletal muscle tissue, which is the muscle tissue that our arms, our legs, and our pelvic floor are made of, gets thinner, so it doesn't have quite as much muscle bulk, which therefore can be weaker unless it’s trained to bulk up through exercise,” she says. Decreased muscle mass also leads to burning fewer calories, which may contribute to weight changes. Staying active can help you get stronger and manage these symptoms, so talk to your doctor about how physical therapy and exercise may help you.
Coping with Fatigue, Fog, and Confusion
Getting stuck halfway through a sentence, racking your brain for where you placed your keys, or blanking on someone’s name – brain fog isn’t fun, but it’s a completely normal experience during treatment induced menopause. Dani and Rachel also recall psychological symptoms like feeling confused about their symptoms.
“At least for me, I can only speak from my own lived experience, I felt crazy initially,” says Dani, now 38, who experienced a range of symptoms like insomnia, fatigue, joint pain, bloating, anxiety, and moodiness as her periods started becoming less and less frequent following chemotherapy and during tamoxifen, her long-term hormone therapy course. “Was I making this up? Was this just me being in my head?” she says.
Rachel says brain fog was especially difficult while she was continuing her job. “It’s caused me to have a bit of a crisis of confidence from time to time. You then start to worry and overthink. ‘Oh god, I couldn’t speak. What must they think of me? Am I good at my job? No, I can’t do this anymore.’ It’s such a psychological impact,” she says. To keep her mind active, she has started taking dance classes, journaling, and dedicating time to learning new things.
Lubes and Moisturizers: Managing Vaginal Dryness
For treating vaginal dryness, Dr. Kathryne Sanserino, a gynecologist at Stanford Medicine who works with cancer survivors, says there are three goals: reducing friction, retaining moisture, and restoring vaginal estrogen. To reduce friction, she recommends using lubricants with low osmolality, meaning you should look for products with no parabens, glycerins, or additives. Hyaluronic acid-based vaginal moisturizers are the best for retaining moisture, she says, and it’s important to ask your doctor how to properly rub the product in when applying it for optimal effect. Vaginal estrogen can also be prescribed, and it is often still safe for patients with hormone-positive cancers, Dr. Sanserino says. (Read our recommendations here).
“We have a lot of safety data, abundant safety data at this point, telling us that local estrogen therapy is safe,” she says. “There will be more natural lubrication, and the tissue quality will improve. It'll be more plump, and then also it'll increase the blood flow to the vagina which can help with libido, as well.” Talk to your doctor about what vaginal products are best for you, whether they be over-the-counter or prescribed.
You May Feel Alone; Know You’re Not
In addition to the draining side effects, going through menopause so suddenly and at a younger age than most of your friends can feel isolating.
“I think good friends are happy to listen and empathize, but it's very different knowing that your peers are not going through what you are. Sometimes I don't relate to conversations about what they're going through and that's crappy,” says Dara, who was diagnosed with breast cancer when she was 39.
Rachel says finding online support groups and talking to women going through similar experiences was comforting for her. Now, she is the executive director of Menopause and Cancer, a U.K.-based organization dedicated to providing resources and community to women experiencing cancer-induced menopause.
“It sometimes feels a little bit wrong to moan about symptoms. You know, ‘you survived cancer, why are you moaning?’ I think quality of life is really important and I think being able to share and chat to people in the community about how you're feeling…is one of the most important things,” she says.
How Do I Talk to My Doctor About Treatment-Induced Menopause?
Dr. Senapati says that there are additional medications or products that can help mitigate some of your menopausal symptoms. Dani says it’s important to advocate for yourself and communicate with your doctor about any symptoms. “There are no stupid questions and there is no stupid thing to bring up,” she says. “You should talk and fight for what you’re feeling because it's your body and no one else can feel what you’re feeling.”
Treatment-induced menopause can be a more difficult hurdle than menopause for most women: the onset is quicker, you may be the only one of your similarly aged friends going through it, and it’s another challenge on top of what you are already juggling with cancer. You deserve to be informed and ready for whatever may come, so talk to your doctor about what side effects you may expect and how you can best address them together.
