Menopause at the expected age

It’s common for women to reach menopause between the ages of 45 and 55 years. In Australia, the average age for women to reach menopause is 51 to 52.

About 20% of women have no menopausal symptoms. Other women may experience different symptoms, such as hot flushes, sleep disturbance, vaginal dryness, mood changes and sore breasts.

As you approach your final period, you may:

• have shorter or longer menstrual cycles
• have heavier or lighter periods
• continue to have normal periods until they stop
• have more painful periods
• experience PMS.

Premature ovarian insufficiency (POI)

Premature ovarian insufficiency (POI) can cause premature and early menopause.

POI is when your periods stop suddenly at an earlier than expected age.

Menopause due to cancer treatment

Menopause can happen because of cancer treatment, such as chemotherapy or radiotherapy. These treatments can cause your ovaries to stop working. The sudden change in hormones, particularly oestrogen and testosterone, may lead to more severe symptoms.

Not all cancer treatments will cause menopause. Depending on the treatment, menopausal symptoms may be temporary or permanent. Other factors may influence permanent menopause, such as your age and the type of chemotherapy undertaken.

Breast cancer is the most common cancer affecting women; therefore, much of the information and research about cancer and menopause relates to breast cancer. But treatment for other cancers (including childhood cancers, non-hormonal cancers and hormonal cancers) can also result in menopause.

Studies show that 25% of women who develop breast cancer are not postmenopausal. This means that cancer treatment may cause them to experience menopause earlier than expected.

Menopausal symptoms related to cancer treatment

It can be hard to distinguish between ‘normal’ menopausal symptoms and symptoms caused by the cancer.

Research suggests that young menopausal women with breast cancer may experience:

• bladder, vaginal and vulval problems: 50–75% of women with breast cancer report one or more symptoms, such as dry vagina, itching, pain during sex or urinary tract infections
• depression and anxiety.

Women may experience symptoms like hot flushes and night sweats due to natural menopause, cancer treatments (e.g. chemotherapy or endocrine therapy) or stopping menopausal hormone therapy (MHT).

Reactions to menopause after a cancer diagnosis

If you go through menopause and cancer at the same time, it can be very distressing. It is normal to experience a sense of sadness and loss of control.

It’s important to talk to someone if you feel emotional, anxious or depressed. Your doctor can help with symptom relief and refer you to a psychologist if needed.

There are lots of things you can do to look after yourself during this difficult time. You can also discuss the risks and benefits of different hormonal, non-hormonal and complementary treatment options with your oncologist and other treating doctors.

Cancer treatment and fertility

If you would like to have children (or more children) you can ask your oncologist about options to preserve your fertility. This must be done before you start chemotherapy or radiotherapy. Your options may include:

• embryo freezing
• egg freezing
• ovarian preservation
• ovarian biopsy and freezing.

Watch these YouTube videos about fertility after cancer, produced by the Victorian Integrated Cancer Service.

Sex and intimacy after cancer

Treatment for some types of cancer can affect your physical ability to have or enjoy sex. It can also affect your desire to be sexually intimate.

Visit the Cancer Council Victoria website to learn more about sex and intimacy after cancer.

More information about menopause due to cancer treatment

For more information about chemotherapy and fertility:

• download the Cancer Council’s Fertility and Cancer booklet

• read the Breast Cancer Network Australia’s ‘My journey kit’.

Menopause due to surgery

Menopause can happen because of surgery, such as the removal of your ovaries or uterus due to cancer or other health conditions such as severe endometriosis.

Removal of ovaries

Menopause will happen if you have surgery to remove your ovaries.

Both of your ovaries may be removed if you have:

• severe endometriosis that causes chronic pelvic pain
• chronic pain because of pelvic inflammatory disease (PID)
• ovarian cancer
• a high risk of developing breast or ovarian cancer, which can be because:
  • you have a strong family history of breast or ovarian cancer
  • you have a genetic variant (BRCA-1 or -2) that increases your risk of developing breast or ovarian cancer.

Hysterectomy

A hysterectomy is the surgical removal of your uterus. Most women who have a hysterectomy do not go straight into menopause. But women who have a hysterectomy and keep their ovaries are more likely to have an earlier menopause.

Managing menopause after surgery

If your menopause is caused by surgery, your oestrogen and testosterone hormones will suddenly drop, causing symptoms to be more severe than normal.

The best way to manage these symptoms is with menopausal hormone therapy (MHT). Your doctor can advise you about the risks and benefits of using MHT.

MHT may not be an option after surgical menopause (e.g. if you have a hormone-sensitive cancer). If this is the case, you can explore other options such as non-hormonal therapies, complementary therapies and medicines.

When your ovaries are removed but not your uterus, MHT will include oestrogen and progestogen, with or without testosterone. Progestogen protects against uterine cancer.

When both your ovaries and uterus are removed, MHT will include oestrogen and possibly testosterone. Progestogen is not needed as there is no risk of uterine cancer. In this situation, you should start therapy within one week for relief of symptoms such as hot flushes, and for bone preservation.

If you are under 45 years of age when you experience surgical menopause, the drop in oestrogen levels can increase your risk of osteoporosis. It can also increase the risk of early development of cardiovascular disease (e.g. heart disease).

Talk to your doctor about how to manage menopausal symptoms and reduce the risk of further health complications.

Reactions to menopause after surgery

After surgery you may feel different emotions, depending on the reason for your surgery and what’s happening in your life.

After surgery, some women say they feel free from pain and more sexual, while others feel less sexually attractive.

Your experience may also be influenced by factors such as your age, whether you are in a relationship, your family plans and whether you have good supports.

There are lots of things you can do to look after yourself during this difficult time.

It’s important to talk to someone if you feel very emotional, anxious or depressed after surgical menopause. Our team are here to help.