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.
2. Chemotherapy
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.
3. Radiation
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.)
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