Medically induced menopause is almost universal during ovarian cancer treatment. Most women naturally have menopause between ages 45 and 55. Premenopausal women treated for ovarian cancer will likely be pushed into early menopause. Sudden medically or surgically induced menopause is often harsher than natural menopause that occurs over some years. There are also long-term complications like early bone loss from having low estrogen levels that start before natural menopause.
Treating these symptoms can lower your risk of having more health problems and improve your well-being. Talk to your health care team about treatment options if you’re having menopausal symptoms like hot flashes, mood swings, sleep problems, joint pain, low sex drive, or vaginal dryness.
What Ovarian Cancer Treatment Can Induce Menopause?
Your treatment plan will depend on the size and type of ovarian cancer, where it is, how far it has spread, and your age and health status. But treatment can include surgery, chemotherapy, radiation therapy, or hormone therapy. Induced-menopause symptoms are a side effect of all of these treatment options.
Surgery
Your doctor will decide if and which surgery is best for you, depending on how far your cancer has spread.
A surgery that removes both of your ovaries and fallopian tubes, called bilateral salpingo-oophorectomy, will cause you to start having menopausal symptoms.
Because the ovaries produce estrogen hormone, without them, you’ll lack this hormone, causing sudden menopause symptoms. This type of menopause is called surgical menopause and is the most common type of premature or early menopause.
Surgical menopause, especially before age 45, is tied to long-term health problems like heart disease, stroke, dementia, Parkinson's disease, sexual dysfunction, bone loss, and mood problems.
Radiation therapy is a cancer treatment that uses radiation to damage cancer cells. Your doctor might recommend radiation therapy to manage your symptoms or treat other body parts where cancer has spread.
If radiation gets to your ovaries, it can damage them. This damage can occur if you get radiation to your ovaries, pelvic area, vagina, stomach area, or other body parts close to your ovaries.
Your age, how many healthy eggs you have in your ovaries (ovarian reserve), and your radiation dose can also determine whether radiation therapy will cause menopause to start.
Chemotherapy can cause early or premature menopause and lower your chances of becoming pregnant.
Your age, the type of chemotherapy medication you receive, and the dose will determine the damage chemotherapy does to your ovaries.
Research shows that alkylating agents, a class of anti-cancer drugs used during chemotherapy, are highly toxic to the ovaries. And three common chemotherapy drugs, also belonging to the alkylating medication class – cisplatin, cyclophosphamide, and doxorubicin – can damage the ovaries.
Other medications can also damage your ovaries but have lower risks, compared to alkylating agents. Some of these medications are:
- Platinum-based agents like carboplatin and cisplatin
- Antimetabolites like 5-fluorouracil, cytarabine, and methotrexate
- Vinca alkaloids medications like vinblastine and vincristine
Although hormone therapy is not a common ovarian cancer treatment, your doctor may include it in your treatment plan when necessary. This therapy involves taking medications that stop the ovaries from producing estrogen or reduce estrogen levels, resulting in menopause symptoms.
Examples of medications used in hormone therapy that can cause menopausal symptoms are:
- Luteinizing-hormone-releasing hormones (LHRH) agonists like goserelin and leuprolide
- Tamoxifen
- Aromatase inhibitors like anastrozole, exemestane, and letrozole
Side Effects of Induced Menopause
Treatment-induced menopause may cause symptoms similar to typical menopause but could be more severe.
Some induced-menopause symptoms you might have are:
- Hot flashes
- Night sweats
- Sleep problems
- Vaginal dryness
- Low sex drive
- Fatigue
- Headache
- Weight gain
- Urinary problems
- Mood disturbance
- Muscle and joint pains
Over time, ovarian cancer treatment-induced menopause may also increase your risk of health problems like:
- A decline in thinking skills
- Mood disorders like anxiety and depression
- Bone loss
- Heart disease
- Sexual dysfunction
- Obesity
How to Handle Ovarian Cancer Treatment-Induced Menopause Symptoms
If you’re having some of the symptoms of induced menopause, it’s best to talk to your care team. They’ll create a treatment plan for you. When creating a treatment plan, your doctor will consider:
- Your age
- Type and stage of the cancer
- How severe your menopausal symptoms are
- How the symptoms affect your quality of life
If your symptoms are mild, they might only recommend lifestyle changes. If your symptoms are moderate or severe, you might get medications to manage them.
Lifestyle changes
Your cancer care team might recommend behavioral, exercise, and diet changes that may ease menopausal symptoms, like weight gain, hot flashes, vaginal dryness, night sweats, and poor mood.
These lifestyle changes may also help manage your risk of health problems like bone loss, heart diseases, and obesity.
Generally, your health care team might tell you to:
- Have more calcium and vitamin D foods and supplements for healthier bones
- Get better and more regular sleep
- Avoid alcohol, caffeine, and spicy foods
- Sit less and move more
- Do strength training and aerobic exercises to stay fit and keep your bones strong
- Drink more water
- Manage stress levels
- Wear light clothing, spend more time in cooler places, drink chilled water, and have a portable fan wherever you are to manage hot flashes
- Use vaginal lubricant or moisturizers to relieve vaginal dryness or irritation.
Non-hormonal medications
Your doctor may recommend antidepressants to manage hot flashes, night sweats, and mood changes. Examples of antidepressants you might receive are:
- Citalopram
- Desvenlafaxine
- Fluoxetine
- Paroxetine
- Sertraline
- Venlafaxine
Other medications that can help manage menopause symptoms are:
- Clonidine, a medication that lowers blood pressure
- Gabapentin, a prescription for treating seizures
- Oxybutynin, a drug for treating overactive bladder
Speak with your doctor about non-hormonal medications for your symptoms. They can best prescribe medication that’s right for you.
Seeing a therapist
Treatment-induced menopause can affect your mental and emotional health. You might have poor self-image or low self-esteem, intimacy problems in your relationships, sexual problems, and mood swings. You might also feel down about your chances of ever having a baby.
Your doctor might refer you to a therapist or other mental health professional or support group to improve your mental health due to premature or early menopause.
Therapy may also help you manage anxiety and depression symptoms, stress, hot flashes, and sleep problems.
Induced menopause can cause sudden side effects that drastically affect your well-being and quality of life. Speak with your doctor about any symptoms you might be having during or after ovarian cancer treatment.
