Managing induced or surgical menopause can be a huge shock, especially when you were expecting menopause to happen during your 50s. Lisa Punt from Maggie’s Centres shares how support and knowledge can really help women deal with the triple impact of cancer diagnosis, treatment and induced or surgical menopause.
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Supporting women with medically induced menopause
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What does induced menopause and surgical menopause mean?
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Induced menopause and surgical menopause symptoms
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What’s the psychological impact of induced menopause?
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How can you manage induced or surgical menopause symptoms?
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What does an induced menopause mean for your fertility?
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Support following medically induced menopause
Maggie’s is a charity that offers free cancer support and information from its 24 centres across the country. Lisa Punt, centre head of Maggie’s Cambridge, chatted to us about the charity’s workshops for women managing cancer and menopause.
“We support women with cancer and their treatment-induced menopause through workshops that have a formal structural but informal atmosphere. We focus on legitimising their experiences and help them understand what is happening as a result of their menopause. The impact of their treatment can be far-reaching and the opportunity to talk to others in a similar position can be incredibly helpful.”
When is the right time for induced or surgical menopause support?
“Our workshops have really evolved over the last three years to meet the needs of those women experiencing menopause alongside cancer. We noticed initially that women were just overwhelmed when they attended and too much information was not helpful. Now it is much more about sharing experiences, particularly around the impact on relationships and mood but also thinking about how we can optimise bone health through nutrition and exercise. As our groups bond, the more they want to continue the connection. Now, when anyone’s completed the menopause workshop, they can come into our monthly support group.
“I often get asked when is the best time to get support for menopause. There is no right time, it’s when it feels right. At Maggie’s we are able to support women at a time that feels right for them. The longer term recovery from cancer treatment can take more time than expected and therefore we need to offer information and support when needed.
Many people will have treatment for fatigue for two years post-treatment. No one tells you that and this is when psychological distress may hit.”
“It is important there is a discussion early on in diagnosis about the impact of their treatments on menopause and long-term health. Women need to understand the importance of bone health and cholesterol levels. It’s not just about managing menopause symptoms but managing the physiological changes to your body.”
What does induced menopause and surgical menopause mean?
Surgical menopause
Surgical menopause is when you have your ovaries removed, either due to cancer or to prevent ovarian cancer. Removing both ovaries leads to permanent and immediate menopause
Medically induced menopause
Medically induced menopause is an umbrella term that includes surgical menopause as well as menopause due to medication, such as chemotherapy, stopping your ovaries from functioning. Sometimes it is permanent, and sometimes it is not.
- Ovary removal: As explained above
- Chemotherapy: Depending on the treatment type, chemo can induce temporary menopause, meaning that your periods stop while having treatment and recovering. However, in some cases, it can be permanent
- Radiotherapy: Induced menopause risk is higher if your treatment is around your pelvis. In some cases, the ovaries can be relocated higher up if the pelvis needs radiation. This is called ovarian transposition and is often done by keyhole surgery before your radiotherapy starts.
Is induced menopause permanent?
Induced menopause can be permanent or temporary, depending on your diagnosis and type of treatment. It can be distressing to go through getting a diagnosis, undergoing significant treatment, and then having to deal with menopause symptoms.
Induced menopause and surgical menopause symptoms
There are over 34 menopause symptoms and you may get some or many of these – after all, each woman’s experience of menopause is completely unique. If you are in menopause after a hysterectomy or have an induced menopause, you might experience the following symptoms:
- Low mood
- Anxiety
- Weight gain
- Hot flushes
- Vaginal dryness
- Brain fog
- Leaking pee
- Low energy
- Sleep issues
Women who are going through induced menopause or experience menopause after surgery to remove their ovaries will need specialist support. Symptoms can be more intense than spontaneous menopause, and the consequences on long-term health can be more significant, such as the risk of osteoporosis. Symptoms do not appear gradually as with spontaneous menopause but suddenly and abruptly, or over a relatively short time.
Lisa says: “It’s important to understand that the impact of cancer treatment and menopause is even greater because you have a complete reduction in hormone levels, oestrogen and androgens, and not a gradual decline. That means that symptoms may suddenly appear, which can be very challenging after cancer treatment.”
What are symptoms like for premenopausal women?
Induced menopause symptoms can be more intense for women who are premenopausal.
I am postmenopause, will I get symptoms?
Lisa said: “You can go through spontaneous menopause, be diagnosed with cancer, have a hysterectomy, and begin to have hot flushes again. This is because oestrogen can still be produced by your adrenal glands and fat cells, but the anti-oestrogen medication or chemotherapy blocks this, resulting in menopause-like symptoms.”
What’s the psychological impact of induced menopause?
For women that have had a cancer diagnosis, it can be a shock to deal with cancer and then face the symptoms of induced menopause. The combined impact of cancer, the stress of diagnosis and treatment, and then unexpected menopause is a massive thing to deal with. You may find recovery complex, with low mood and libido.
Lisa says: “Younger women feel they are ageing quicker than they should be. They don’t feel the same emotions they used to feel. They may be concerned about body image, particularly if they’ve had a mastectomy or hysterectomy. It may not be visible but is a huge part of who they are.
“One woman shared, ‘You get hit with a cancer diagnosis and then the menopause comes along. The two are equally big but you get support for cancer. I am incredibly grateful that my cancer has gone but I now have to deal with menopause, something that I would not normally be dealing with at my time of life’.”
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How can you manage induced or surgical menopause symptoms?
HRT
Lisa says: “There’s a wide range of experiences with induced menopause due to cancer and cancer treatment. A lot of it comes down to whether your cancer is hormone-sensitive or now. For example, the majority of cervical cancers are not oestrogen sensitive and the NICE recommendation is for these women to be offered HRT until they’re 50. While oestrogen-sensitive tumors, such as many breast cancers, will be given treatments that block either the production or the uptake of oestrogen, such as Tamoxifen and Letrozole, and HRT will not be suitable.”
If you have just had a cancer diagnosis, will you have to stop taking HRT?
It is possible that you will need to stop your HRT if your cancer is oestrogen-receptive. If you need to stop taking HRT, you may experience a sudden onset of menopause symptoms that can be challenging. Talk to your doctor about what treatments are available.
Here is a list of red flag symptoms, where seeing a doctor is a good idea.
Lifestyle changes
Taking care of stress, boosting exercise, looking after your sleep and nutrition can really help manage many menopause symptoms, from hot flushes to sleep issues and weight gain to low mood.
Avoiding spicy food and keeping rooms cool and clothing light can help particularly with hot flushes. Mindfulness and yoga are great to rebalance your mood.
Maggie’s is recommending Stella to those attending their workshops as a way of managing their most bothersome symptoms.
Lubrication
Talk to your doctor about what treatments are available for vaginal dryness, which can lead to urinary tract infections (UTIs). There are many products available that may help.
Antidepressants
Antidepressants can sometimes be used to help with menopause symptoms, especially if you can’t have HRT. Talk to your doctor if you think this could be an option for you.
Supplements
Talk to your doctor before taking anything, as supplements may interfere with your treatment, particularly if you have a cancer diagnosis.
What does an induced menopause mean for your fertility?
Lisa says: “Loss of fertility, whether people want children or have completed their family is still a massive issue as the choice is being taken away from them.
“There are some types of chemotherapy that may impact on the ovaries to a point where you become infertile, and the hormone levels don’t ever regain enough to become fully fertile.
“Certainly, radiotherapy to the pelvis is a permanent treatment that can cause infertility, just because the ovaries are so sensitive to radiation. Some women with cervical cancer need to undergo local radiotherapy to the pelvis, and typically suffer infertility due to the treatment.
“Sometimes, we can offer egg collection before radiotherapy treatment starts. This means there is a delay to starting treatment but this can often be a very difficult decision to make. However, there are certain surgical procedures for some early-stage cervical cancers where fertility can be maintained. A procedure that allows part of the cervix to be removed without affecting the womb means normal fertility can be maintained.”
Final word
Induced and surgical menopause can be huge challenges, especially if they happen as part of cancer treatment. It’s important to remember that there is help out there. Speak to your doctor for medical advice or your local Maggie’s Centre if you are going through cancer treatment.
For more information about other menopause topics, read more on our blog or symptoms library.
- Honigberg MC, Zekavat SM, Aragam K, Finneran P, Klarin D, Bhatt DL, Januzzi JL, Jr Scott NS, Natarajan P 2019, ‘Association of Premature Natural and Surgical Menopause With Incident Cardiovascular Disease’ JAMA, vol. 322, p. 2411
- Kaunitz AM, Faubion S, 2020, ‘Surgical menopause: Health implications and hormonal management’, Menopause, vol. 28, no. 1-3
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