Natural, spontaneous menopause occurs when a woman experiences the end of menstruation without the use of any drugs to assist the process. Natural menopause in women occurs in three main stages; perimenopause, menopause, and postmenopause.
However, in some cases, women do not go through the natural process of menopausal transition and may need medical treatment. This process is called induced or medical menopause. In medical menopause, a woman’s cycle is stopped prematurely as a result of medical treatments such as chemotherapy or surgery. Medically induced menopause can also be prescribed for higher-risk patients such as those with high blood pressure, a breast cancer diagnosis or those at risk of heart disease.
Treatment-induced menopause is not a long process and causes the menopause to occur in a short time. The amount of time it takes for medical menopause to take effect depends on various factors including the personal history and circumstances of the individual being treated.
Naturally, your healthcare provider is best positioned to give you specific advice to suit your needs, however, the aim of this guide is to help you understand some of the terminology and experiences associated with medical interventions and how the management of menopause can be made easier with the right advice, support and an effective treatment plan.
What Causes Medical Menopause Symptoms?
A number of medical procedures and treatments can help induce medical menopause and you should consult a doctor before choosing any option. Here are some medical procedures that may cause premature menopause or induced menopause in women.
Surgical menopause occurs when a woman’s ovaries are surgically removed while she is still ovulating (oophorectomy). The most immediate effect of oophorectomy is the change in all three ovarian hormones; testosterone, oestrogen, and progesterone.
All these hormones are released by the ovary and their levels fall by as much as 50 percent. As a result, this can cause severe symptoms that may affect postmenopausal women.
But, at what point is surgical menopause advised?
The reasons behind the removal of ovaries may differ from person to person and it is mostly a recommendation from the doctor. Generally, you may be advised to remove both ovaries before the age of menopause because of:
- Ovarian cancer.
- When there is an increased risk of ovarian cancer, breast cancer, or heart disease. This can be diagnosed if you have a family history of ovarian or breast cancer or certain genetic variants that show you are at a higher risk.
- Chronic pelvic pain due to pelvic inflammatory disease (PID), a condition that causes infection of the ovaries.
- Endometriosis - when severe and interferes with daily life.
The symptoms of surgical menopause can be severe because its effects are immediate and abrupt. During surgical menopause, doctors recommend going for menopausal hormone treatment (MHT) but it is advisable to discuss the effects of this with your doctor.
Vaginal bleeding after menopause can also occur but is usually the sign of a noncancerous condition. Regardless of the severity, you should always get this checked out by a qualified healthcare professional.
Side effects of surgical menopause
Surgical menopause can be an extremely challenging treatment for women. It can leave some patients with physical and emotional side effects which can sometimes prove overwhelming. It is important to seek emotional support at this time.
The effects of surgical menopause can affect your daily life and even that of others. Some women report that once they undergo surgical menopause, they feel more freedom from pain and become more sexually active with a whole new 'lease of life'. In contrast, some complain of hormonal fluctuations, mood disorders or feelings that affect their self-esteem.
Chemotherapy is a process that kills all fast-dividing cancerous cells in the body. Likewise, the cells in the ovaries are also rapidly dividing and as a result, they get affected by chemotherapy.
Depending on the person, chemotherapy can affect your cells permanently or you may recover after some time. During chemotherapy, there is a high chance that female patients will have irregular menstrual cycles or see the complete disappearance of periods.
When you start chemotherapy, you may notice menopausal symptoms after a couple of months and these symptoms may prevail for years after treatment. Such menopausal symptoms include hot flashes, vaginal dryness, night sweats, weight gain and painful intercourse.
For women over 40, chemotherapy can cause the onset of menopause, which will continue up to postmenopause. For those aged 30 or younger, chemotherapy may result in the onset of menopause symptoms, but periods may return in the future.
Side effects of menopause chemotherapy
When menopause is induced through chemotherapy, there are various side effects as a result. The most common side effects are emotional and can include a lack of motivation, energy loss, irritability, difficulty concentrating, insomnia, headaches and anxiety, among others.
Chemotherapy can also cause vaginal side effects to occur. Low levels of the oestrogen hormone may result in vaginal dryness and a lower sex drive. Treatment options may include oestrogen replacement therapy, especially in younger women who have a lower risk of permanent menopause.
There is also a risk of getting osteoporosis. This is the sudden loss of bone mass which results in a more porous bone. When your bone is weak, there is a high chance you will have a fracture in soft landings. Osteoporosis is not necessarily a symptom of menopause, but it has been reported to be one of the effects in women with menopause.
Radiation therapy is a treatment for cancer and it works almost the same way as chemotherapy. It employs beams of high energy to remove cancerous cells. Since it is not targeted to cancerous cells, radiation therapy also kills normal cells (oestrogen and progesterone) in the process. Pelvic radiation therapy is used to kill cancerous cells causing cervical cancer which also affects the ovaries.
As a result, radiation therapy ends up damaging the dividing cells produced by ovaries leading to induced symptoms of menopause. Depending on the doses given, a woman may or may not recover once the radiation therapy is administered. Some of the common symptoms associated with pelvic radiation include vaginal dryness, vaginal atrophy, and hot flashes.
Side effects of radiation therapy
Radiation therapy causes early menopause but in some cases, it is not permanent if the woman is below the age of 50. So, it is important to take care if you are having pelvic radiotherapy to avoid an increased risk of unplanned pregnancy or complications when you get pregnant.
Vaginal tissue is quite sensitive and radiation irritates the walls, making them tough and leathery. The walls may lose elasticity which can cause pain during intercourse.
In some instances, the bowel and bladder get affected which can be uncomfortable during sex. Emotional side effects of radiation therapy include depression, mood swings, irritability, and lower concentration.
Managing these side effects can be difficult, especially after going through any form of cancer treatment. The best way to manage the side effects of radiation therapy is by getting help from a doctor, living a healthy lifestyle, taking specialised menopause support medications and seeking emotional support to help ease your burden.
Ovarian Suppression Therapy (and breast cancer treatments)
As the name suggests, ovarian suppression therapy is a treatment used to suppress the ovaries from producing oestrogen and is usually used in women with breast cancer.
During this period, OST may be administered once a month as it signals the brain to prevent ovaries from making oestrogen. Once you stop these medications, your menstrual cycle should come back to normal.
However, not every woman recovers from OST and at times it triggers early menopause. There is a high likelihood that women below 40 will recover from this and continue with their cycles as normal.
However, in most cases where the woman is near menopause, OST treatments induce menopause which continues until the postmenopausal stage.
Medical Menopausal Symptoms
Symptoms of medical menopause are similar to those of a natural menopause and they often come more rapidly than they would in natural menopause. Women most affected by this are those that have had their ovaries removed, which induces menopause rapidly.
Some of the symptoms of induced menopause include:
- Night sweats
- Memory issues
- Skin and hair changes
- Aches and pains
- Weight gain
- Mood changes
- Drop in hormone levels
In natural menopause, the most common treatment option is hormone replacement therapy (HRT) or menopausal hormone therapy. It can be administered as creams, orally, or in a patch placed in the vagina. However, this type of treatment is not preferred for patients who have induced or medical menopause. The ideal options recommended by doctors for this kind of menopause include:
- Local vaginal oestrogen treatment and lubricants or taking vitamins to help with dryness
- A healthy diet and weight management program
- Melatonin to relieve insomnia
- Neurontin to manage hot flashes
Other options to manage your induced menopause will require you to have a chat with support groups or doctors. As there are a multitude of drugs for managing medical menopause, it is important to have a conversation with your doctor and discuss the options available.
You may also be tempted to try herbal remedies, but be wary that there isn’t enough research done on herbal medicine and its safety in your body. You could potentially be treating a side effect only to introduce other complications.
So, anytime you opt for herbal treatment, ensure you consult your doctor first. We have seen patients taking soy products as they contain a weak form of oestrogens called phytoestrogens and may help alleviate symptoms of induced menopause.
The Meaghers Verdict on Medical Menopause
If you or your loved one is experiencing symptoms of medical menopause, please make sure to visit your nearest doctor for assistance. It is important to note that induced menopause may have adverse emotional effects on women of a younger age.
Contact Us to Discuss Your Menopause Health
We hope this guide has equipped you with the support and knowledge to understand some of the complications associated with the impact of a medical menopause and what course of action you can follow to remedy it. It’s important to know that you're not alone on this journey and professional help is on hand to assist you at all times.
The first step is always the hardest, but once you’re through it, you'll be more confident about your body, your general well being and looking forward to the next chapter of your life!