Before Payton Steele was diagnosed with Hodgkin’s Lymphoma, she never imagined she would go through menopause when she was barely out of her teen years. Two months into chemotherapy, Steele’s period disappeared, and she began to develop hot flashes. Then came the hair loss. Although she finished her treatments in September, the early menopause symptoms continue to affect her daily life, Steele tells SELF, but above all, her self-confidence. “It's definitely not something I thought I would have to deal with at 20,” she says. “And knowing that I might not be able to have kids in the future is just really rough and makes me really sad.”
This is the reality for a lot of younger people who’ve been diagnosed with cancer. Most folks with a period transition into menopause sometime between the ages 45 and 55. At that point, their ovaries start to produce less of the hormones estrogen and progesterone. But medical menopause—when your ovaries are removed, shut down, or stop working as a result of chemotherapy, radiation to the pelvis, medications, or surgery—can mean this process begins well before age 45. It’s often referred to as early or premature menopause (but we’ll stick with “early” for simplicity’s sake).
Symptoms like hot flashes, sleep problems, mood changes, and vaginal dryness can hit pretty hard following cancer treatment. That’s because your ovaries lose their function right away, as opposed to gradually as you age. But the likelihood your cancer treatment puts you into early menopause depends on several factors, including the age you were diagnosed and the dose and type of therapy you receive. It’s also not always a permanent situation; some people’s ovaries can start back up again after a little break.
Whether your early menopause is temporary or lifelong, the situation is still pretty crappy. But there are a number of ways you can find relief from your symptoms, and some people may even be able to prevent issues like infertility. Here’s everything to know about how cancer treatment can affect your risk of early menopause.
3 cancer treatments that can cause early menopause
Sometimes the best thing you can do to get rid of your cancer and lower the chances it comes back is to surgically remove both of your ovaries (known as an oophorectomy). This is especially true for ovarian cancer, or any other that can spread into the ovaries (like colorectal cancer, for example). This type of procedure is “an automatic ticket into menopause,” Shanthi Sivendran, MD, a medical oncologist and senior vice president of cancer treatment support with the American Cancer Society, tells SELF. If your ovaries are removed, your period won’t come back and your hormone levels will drop quickly, which means menopause starts right away and your symptoms may be really intense. In some cases, though, your doctor may try to leave one or part of an ovary, which can help prevent early menopause.
You may also need to remove your ovaries if you carry a genetic mutation (specifically the BRCA1 or BRCA2 genes) that increases your risk of certain diseases, Dr. Sivendran says. One study found that women who underwent this surgery had a 96% and 53% reduction in their risk of ovarian and breast cancer, respectively. These specific cancers are estrogen-dependent, meaning they rely on this hormone to grow; so removing the organ that produces it essentially starves and prevents them from developing in the first place. If your surgeon removes your uterus (but keeps your ovaries) as part of your cancer treatment, you may not go into early menopause right away, but you might develop it a year or two earlier than normal.
All types of chemotherapy have the potential to affect your ovaries, but certain types that use drugs like Cytoxan (which can treat a bunch of cancers, including Hodgkin’s lymphoma, multiple myeloma, and breast cancer) are known for causing early menopause. This is because chemo destroys rapidly dividing cells in the body, which includes cancer cells and the normal cells in your ovaries.
Some data indicate that a lot of people who initially go into early menopause get their periods again about two years after they finish chemo. But again, this depends on what kind of drug you receive, the cancer you have, and your age. For example, one type of chemo that people with leukemia or lymphomas may get before a stem-cell transplant is known for inducing early menopause in about 80% of people. Generally, though, the older you are, the higher your risk of developing early menopause and the harder it may be for your ovaries to recover.
This is one of those cancer treatments that’s very much dose dependent, meaning the more radiation you get, the greater your chances of going into early menopause. If you get radiation near your ovaries, it’s pretty much guaranteed that you’ll be kicked into menopause territory. Meanwhile, any radiation done in your pelvis region, say to treat colorectal or cervical cancers, has been shown to cause early menopause in about 94% of women. “Even though we do our best to try to minimize other organs from being impacted, there may still be some radiation exposure to the ovaries,” Dr. Sivendran says.
How do I know if I’m in early menopause?
There’s no exact science to determine whether you’ve hit menopause, but you generally know you’re in it when you haven’t had your period for 12 consecutive months and you’ve been experiencing symptoms like hot flashes, night sweats, and trouble sleeping. However, it can be especially difficult to tell you’re in early menopause after cancer treatment. First, menopause symptoms like fatigue and sexual dysfunction (including low desire, pain, or anything else that prevents you from enjoying sex) can be confused with those related to cancer or the treatment itself. And second, the telltale 12-month-no-period criteria doesn’t always apply to cancer patients because your ovaries may return to regular programming several months to years after treatment, Dr. Sivendran says. Staying in touch with your medical team as you navigate post-treatment symptoms will give you a better idea of whether your menopause is here to stay, and guide you to any therapies you might want or need to feel better.
What does treatment for cancer-related early menopause look like?
Your treatment options are similar to those for people undergoing natural menopause, which may be a low-dose antidepressant to treat hot flashes, for example. But there’s one treatment that some people with early menopause should avoid: Systemic hormone therapy, which is essentially hormones delivered via a pill, patch, foam, gel or spray that affects the entire body, Dr. Sivdenran says. These meds are basically estrogen with or without progesterone. So for people with breast, ovarian, or uterine cancers that rely on one or both of these hormones to grow, this specific therapy may not be safe as it can increase the chances your cancer comes back. Dr. Sivdenran says it’s a good idea to talk with your doctor so you can discuss your personal risk-benefit ratio and ensure that your most concerning symptoms are actually being addressed.
Is early menopause after cancer permanent?
As we mentioned, there are certain scenarios where your ovaries may get back into the swing of things after cancer treatment, but for some people, their early menopause may be permanent. Meghan Karuturi, MD, a breast medical oncologist with the University of Texas MD Anderson Cancer Center, says that age is one of the strongest predictors of this. The younger you are, the more likely menopause isn’t permanent, but it’s “just a measure of time,” she tells SELF, meaning it can take months to years for your ovarian function to return. In a 2016 study, about 70% of the women aged 20–35 who lost their period—an indicator of early menopause—gained it back after their cancer treatment, which included radiation and/or chemo. Most of them got it back within two years, and those on the older side were more likely to have an irregular cycle. (And again, if you’ve had surgical removal of the ovaries or uterus, it won’t ever come back.)
There are circumstances where you can take some steps prior to cancer treatment to reduce your chances of early menopause. For example, if you still can and want to have children after your cancer treatment, you can take luteinizing hormone-releasing hormone (LHRH) agonists that will temporarily stop your ovaries from working. These meds can not only protect your ovaries from damage that might lead to infertility, but they can also make other cancer drugs more effective and even reduce the risk your cancer comes back. You’ll experience typical menopause symptoms when you’re taking these meds, but they should go away when you stop. How quickly that happens is specific to you and your circumstances, though.
If you want to take extra fertility precautions, you can also consider harvesting your eggs before you start your treatment. They can be frozen, or combined with sperm to create embryos first and then frozen, so the eggs can be used in the future to try for a pregnancy. These procedures can be pretty pricey (about $10,000 or more each time you go through a cycle to collect eggs) and not all insurance companies cover it. So be sure to discuss this with your medical team as early as possible to see if this is an option for you and to avoid running into issues that might interfere with your family planning goals.
Does early menopause increase my risks for other health issues?
Yes, it could, but it depends on a bunch of factors. Menopause in general, because of low estrogen levels, can lead to the bone thinning disease osteoporosis, which makes fractures more likely. These hormone changes can also increase your risk of heart disease by affecting things like blood pressure and cholesterol levels. And lots of people can also experience menopause-related brain fog and problems with memory, decision making, and concentration, Dr. Karuturi says.
In practice, that means you might have to get your bone density checked earlier than usual (this typically happens around age 65, but can occur beginning at age 50 if you have certain risk factors like this one), Dr. Karuturi says. It’s also a good idea to chat with your doctor about other preventive measures you can take to lower your chances of these issues, she adds, like exercising regularly and taking certain vitamins.
Above all, early menopause can really put your mental health through the wringer. “It's difficult to feel like you’re going through [menopause] when you didn't anticipate going through it early….. That can impact your daily functioning if you're not getting enough sleep; your work; how you view yourself,” Dr. Sivendran says. “All of these things are just really important struggles that young women who go through early menopause deal with.”
Although early menopause after cancer can feel devastating, there are steps you can take before and after treatment to ease any symptoms or problems. Ask your medical team if your hospital system offers resources to connect patients locally or even nationwide or look for virtual support groups on social media that meet your needs. “It’s just important for you to know that this isn’t something you have to experience in isolation,” Dr. Karuturi says.
This made a world of difference for Steele, who was able to find someone like her who she could rely on for emotional support. “I have a friend who lives super close to me. We had the same cancer, same stage, and we’re the same age, too, which is really cool.”
Related:
- 6 Ways to Deal With Night Sweats During Menopause
- How to Make New Friends as an Adult When You Have a Chronic Illness
- What to Know About Drinking During Menopause
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