Understanding Medically Induced Menopause

Menopause happens to every woman who has periods at some point. In most instances, it occurs between the ages of 45-551 as a natural consequence of the ovaries losing function, whereby the decline of hormones causes periods to stop altogether.

However, around 3% of women encounter premature menopause, with 89% of these cases being medically induced menopause2. While menopause can be difficult to come to terms with and menopause symptoms can be challenging, medically induced menopause presents unique consequences in terms of psychological and sexual well-being3.

In this guide, we explain the types of medically induced menopause and its side effects and explore ways to manage it.

What is medically induced menopause?

Medically induced menopause occurs because of various treatments or interventions that cause the ovaries to stop working properly earlier than they would have naturally done so. This stops your menstrual periods and ends your natural ability to fall pregnant.

Types of medically induced menopause

Surgery

Surgical menopause occurs when the ovaries are removed (a bilateral oophorectomy), which often occurs as part of a hysterectomy or cancer treatment. This immediately halts hormone production, leading to a sudden onset of menopause symptoms, which can be more intense than natural menopause. There are many reasons for this type of surgery but it is typically recommended for medical conditions such as ovarian cancer, severe endometriosis, or genetic risks like BRCA mutations4.

Chemotherapy

Chemotherapy, which is a cancer treatment that uses drugs to eradicate cancer cells, can damage the ovaries, causing them to stop functioning, either temporarily or permanently which often leads to menopause. The extent of ovarian damage depends on factors like age, type of chemotherapy drugs, and dosage5.

Radiation therapy

Radiation therapy to the pelvic area can impair ovarian function by damaging ovarian tissue, leading to menopause. This treatment is common in cases of pelvic cancers like cervical, vulval, vaginal and anal cancer.

The effects depend on the dose and area treated, with higher doses increasing the likelihood of permanent ovarian failure. If you have radiotherapy in conjunction with chemotherapy, this can also increase the risk of menopause6.

Suppressive hormone therapy

Hormones can stimulate some breast cancer cells to grow. Suppressive hormone therapy uses medications to reduce hormone levels, often to treat hormone-sensitive cancers like breast cancer7, however, this can also affect ovarian function, inducing menopause and mimicking natural symptoms. Once treatment stops, ovarian function may return in some women, depending on their age and treatment duration.

Gonadotropin-releasing hormone (GnRH) analogues

GnRH analogues are a modified version of naturally occurring hormones that are used to treat certain gynaecological conditions such as endometriosis and fibroids, PMDD and to reduce recurrence risk for certain types of breast cancer in pre- menopausal women. These medications are designed to temporarily ‘switch off’ the ovaries to create a menopausal state by blocking or lowering the hormones that stimulate the ovaries to produce eggs.

However, these medications are only licensed for short-term use and the menopausal state will only last as long as you are on the medication8.

Medically induced menopause side effects

The symptoms of medically induced menopause are much the same as natural menopause and can vary in severity and duration. They can include:

Hot flushes
Night sweats
Fatigue
Mood changes, including anxiety and depression
Sleep disturbances
Vaginal dryness, itching or irritation
Loss of libido
Pain during sex
Urinary problems such as difficulty controlling the bladder, leaking urine, having to urinate more often and recurrent UTIs
Heart palpitations
Weight gain
Headaches9

The reduced level of oestrogen in the body caused by menopause can also increase your risk of osteoporosis and heart disease10.

Further, medically induced menopause can have a range of psychological effects, including having a negative impact on self-esteem and body image and disrupting intimate relationships11.

How does medically induced menopause differ from natural menopause?

A key difference between medically induced menopause and natural menopause is why they occur. Medically induced menopause is caused by medical necessity as opposed to the natural ageing process.

Medically induced menopause often begins abruptly, causing the sudden onset of symptoms like hot flushes and mood changes. In contrast, natural menopause includes the stage of perimenopause where symptoms can arise gradually over a few months to several years.

Chemotherapy and menopause

The link between menopause and breast cancer, as well as other cancers, is often discussed with regard to the effects of hormone replacement therapy (HRT). However, chemotherapy can cause menopause because certain drugs used in treatment damage the ovaries, preventing them from releasing eggs and producing oestrogen. Chemotherapy destroys cells that divide quickly, like cancer cells. The ovaries also contain rapidly dividing cells, which is why they are affected by chemotherapy.

The extent of the damage depends on factors such as:

The type of cancer
The type of chemotherapy
Dosage
Duration of treatment
Your age
Pre-treatment ovarian reserve
Pre-existing fertility conditions
Other aspects of your medical history

Older women are more likely to experience permanent menopause (and thus, infertility), while younger women may have a chance of ovarian function returning after treatment12.

If you’re of reproductive age and are due to start chemotherapy treatment for cancer, your consultant should discuss your fertility preservation options with you. This may involve retrieving your eggs and freezing them to have biological children in the future through IVF or surrogacy, ovarian tissue preservation or using medication like GnRH analogues during treatment.

How long does medically induced menopause last?

The duration of medically induced menopause depends on the type of intervention involved.

Surgery: Menopause is permanent, as the removal of the ovaries stops hormone production entirely.
Chemotherapy: Menopause can be temporary or permanent; younger women are more likely to regain ovarian function after treatment.
Radiation therapy: Often permanent if the ovaries receive significant damage but may be temporary in cases of lower radiation exposure.
Suppressive hormone therapy: Ovarian function typically resumes once the therapy ends.
GnRH Agonists: Menopause symptoms usually stop, and ovarian function returns after stopping treatment.

Can medically induced menopause be reversed?

Whether medically induced menopause can be reversed depends on the cause.

Surgery: Medically induced menopause from surgical removal of the ovaries is permanent and cannot be reversed because the ovaries are no longer present to produce hormones.
Chemotherapy: Menopause caused by chemotherapy can sometimes be reversed, especially in younger women. Ovarian function may return months or years after treatment, though permanent ovarian failure is common, particularly with higher doses or older age.
Radiation therapy: Menopause resulting from radiation therapy can be permanent, especially if the ovaries were exposed to high doses. However, lower doses or radiation to other areas may allow for some ovarian recovery.
Suppressive hormone therapy: This type of menopause is usually reversible, with ovarian function returning after the therapy stops.
GnRH analogues: Menopause induced by GnRH analogues is temporary, and the ovaries generally function again once the medication is discontinued.

Managing medically induced menopause

There are a variety of treatment options for medically induced menopause, much like there are for natural menopause. Which type is best for you will depend on your unique circumstances and it may take a little time to find the right management approach.

Hormone replacement therapy

Hormone replacement therapy (HRT) is commonly used to manage symptoms of medically induced menopause by replacing the hormones oestrogen and progesterone (and sometimes testosterone) that the body no longer produces.

HRT is effective in alleviating hot flushes, mood swings, vaginal dryness, and preventing osteoporosis but it isn’t suitable or preferable for all women.

Non-hormonal medications

Non-hormonal medications, such as selective serotonin reuptake inhibitors (SSRIs), gabapentin, or oxybutynin can help manage menopause symptoms like hot flushes, mood changes, sleep disturbances and urinary issues14.

These medications are an option for women who cannot use HRT due to health conditions like cancer or blood clots14. While effective for many, they may come with side effects, so it’s important to work closely with a doctor to find the right option.

Herbal remedies

Herbal remedies for menopause, such as black cohosh, red clover, and evening primrose oil can be used to manage symptoms of medically induced menopause, although research on their effectiveness is often limited.

Lifestyle changes

Adopting lifestyle changes can significantly improve the quality of life during medically induced menopause. Regular exercise, a balanced diet, and adequate sleep can help manage symptoms15.

Holistic therapies

Holistic therapies like acupuncture, mindfulness meditation, yoga and CBT for menopause can help with the emotional and physical symptoms16. These therapies focus on reducing stress, improving relaxation, and promoting overall well-being.

Menopause can be a challenging transition to navigate when it happens naturally, but when medically induced, it can be particularly tough. However, you don’t have to go through it alone. The team at Menopause Care are here to help you regain your confidence with tailored treatment, evidence-based advice and emotional support. To get started, book a consultation with a menopause doctor.

DisclaimerAt Menopause Care, we ensure that everything you read in our blog is medically reviewed and approved. However, the information provided is not meant to replace professional medical advice, diagnosis, or treatment. It should not be relied upon for specific medical advice.

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