Cancer treatment - early menopause

Cancer treatments that can cause early menopause include:

• Surgery. Having both ovaries removed causes menopause to happen right away. If you are age 50 or younger, your provider may try to leave an ovary or part of an ovary if possible. This can keep you from having early menopause.
• Chemotherapy (chemo). Some types of chemo can damage your ovaries and cause early menopause. You may have menopause right away or months after treatment. Your risk of early menopause from chemo depends on the type and amount of chemo drug you have. The younger you are, the less likely you will have early menopause from chemo.
• Radiation. Getting radiation in your pelvic area can also damage your ovaries. In some cases, your ovaries may heal and start working again. But, if you get large doses of radiation, the damage may be permanent.
• Hormone therapy. These treatments used to treat breast and uterine cancers can often cause early menopause.

Ask your provider if your cancer treatment may cause early menopause.

When your ovaries are removed or stop working, they no longer make estrogen. This causes the same symptoms as natural menopause.

• Vaginal dryness or tightness
• Hot flashes
• Mood changes
• Lower sex drive
• Problems sleeping

In some cases, these symptoms may come on strong and can be severe.

Less estrogen in your body also increases your risk for certain health conditions, such as:

• Heart disease
• Osteoporosis (thinning of bones)

Many treatments can help ease the symptoms of early menopause. They include medicines and lifestyle treatments you can do at home.

Some medicines that may help include:

• Hormone therapy. In some cases, your provider may prescribe female hormones to help with hot flashes and other symptoms. But, there are some risks with hormones, and you may not be able to take them if you have had certain types of cancer.
• Vaginal estrogen. Even if you cannot take hormone therapy by mouth or skin patch, you may be able to use small amounts of estrogen in or around your vagina to help with dryness. These hormones come in creams, gels, tablets, and rings. You need a prescription from your provider for these medicines.
• Other medicines. If you cannot take hormones, your provider may prescribe another type of medicine to help with hot flashes, such as certain antidepressants (even if you are not depressed) or other medicines. Because of their chemical effects, these are effective for hot flashes even if you are not depressed.
• Lubricants or moisturizers. These products can help make sex more comfortable if you have vaginal dryness. Look for a water-based lubricant, such as K-Y Jelly or Astroglide. Or, try using a vaginal moisturizer like Replens every few days.
• Medicines for bone loss. Some women take medicines to help reduce bone loss after menopause. Ask your provider if this type of medicine may be right for you.

Treatments you can try at home include:

• Staying active. Getting regular exercise can help with mood swings, sleep problems, and mild hot flashes.
• Healthy sleep habits. Getting enough sleep may help ease mood swings. But, if you are having trouble sleeping at night, try skipping naps during the day. You should also avoid caffeine late in the day, and do not have large meals or do anything too active right before bedtime.
• Dressing in layers. This can help with hot flashes, since you can remove layers when you feel hot. It can also help to dress in loose, cotton clothing.

Ask your provider what treatments might work best for you.

Since early menopause can affect your bone and heart health, it's important to take steps to keep them healthy. Here is how:

• Eat healthy foods. Focus on fresh fruits and vegetables, whole grains, lean meats, fish, nuts, beans, and low-fat dairy products.
• Get enough calcium and vitamin D. These nutrients help build bones. Foods rich in calcium include fat-free yogurt and milk, spinach, and white beans. Your body makes most of its vitamin D from the sun, but you can also get it from salmon, eggs, and milk that has vitamin D added. Ask your provider if you need to take supplements.
• Get exercise. The best kinds of exercise for your bones are weight-bearing exercises that work your body against gravity. Some ideas include walking, yoga, hiking, dancing, lifting weights, gardening, and tennis.
• DO NOT smoke. Smoking raises your risk for both osteoporosis and heart disease. If you need help quitting, ask your provider.
• Ask about a bone density test. This is a test that checks for osteoporosis. This is a recommended test for all women at age 65, but you should consider one earlier if you have early menopause.
• Keep track of your numbers. Make sure your provider checks your blood pressure, cholesterol, and blood sugar levels regularly. These simple tests can help tell you if you are at risk for heart disease or stroke.

Premature menopause; Ovarian insufficiency - cancer

Mitsis D, Beaupin LK, O'Connor T. Reproductive complications. In: Niederhuber JE, Armitage JO, Kastan MB, Doroshow JH, Tepper JE, eds. Abeloff's Clinical Oncology. 6th ed. Philadelphia, PA: Elsevier; 2020:chap 43.

National Cancer Institute website. Sexual health issues in women with cancer. www.cancer.gov/about-cancer/treatment/side-effects/sexuality-women. Updated December 29, 2022. Accessed January 17, 2023.

Updated by: Frank D. Brodkey, MD, FCCM, Associate Professor, Section of Pulmonary and Critical Care Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.