Early menopause

Younger women

Chemotherapy, surgery and early menopause

The menopause usually happens naturally between the ages of 45-55 when levels of oestrogen gradually decline and periods stop. 

If you have surgery to remove your ovaries, these hormonal changes will happen straight away. This is known as surgical menopause. Surgical menopause can be overwhelming. If possible, discuss how best to manage this with your medical team beforehand. If you have already gone through surgery it is important to share any worries that you have with your medical team or GP. You can ask to be referred to a menopause specialist, who may be part of a gynaecology or sexual health team.

There’s some risk that chemotherapy will also affect fertility by bringing on early menopause even if your surgery is ‘fertility sparing’ . Whether early menopause is temporary or permanent can depend on your age. 

Symptoms of surgical menopause

Some women experience symptoms more intensely after a surgical menopause because of the abrupt onset of hormonal changes. Some women will not experience any of these symptoms, some will experience a few, and some will experience all.

  • Hot flushes can vary from occasional to very frequent, day and night. They don’t usually last long, but can leave you feeling tired, anxious, frustrated, sweaty, hot, and they can be accompanied by palpitations.
  • Emotional symptoms can include irritability, poor concentration, and poor memory. Sometimes, addressing the hot flushes can improve these symptoms because it means you can get more sleep.
  • Vaginal discomfort and dryness can lead to painful sex.
  • Bladder symptoms can include increased frequency and urgency. These symptoms tend to worsen with time, so seek help sooner rather than later.
  • Other bodily changes can include brittle nails, thinning of the skin, hair loss and aches and pains.

In many cases, these symptoms will get better on their own, although it is difficult to predict how long you may have them for. If symptoms are causing problems in your life, you should discuss treatment options, including hormone replacement therapy (HRT), with you CNS or GP.

Managing your menopause symptoms

Hormone Replacement Therapy (HRT)

Women who go through menopause before the age of 45 are often offered Hormone Replacement Therapy or HRT. HRT can relieve symptoms and benefit long-term health by replacing some hormones. It may not be suitable for all women so should be discussed with your medical team.

HRT is thought to:

  • Prevent loss of bone strength
  • Maintain a healthy heart
  • Prevent cognitive decline in later life (e.g. memory)

How is it given?

After a surgical menopause, HRT is given as one hormone (oestrogen therapy) via tablets, patches and gels. Women who still have a womb will need two hormones, oestrogen and progestogen, but treatment remains the same.

What are the side effects?

You may not experience any, but side effects of HRT may occur in some women and can include breast tenderness, headaches and leg cramps. They usually improve with time. Occasionally a change in dose or type of oestrogen will be necessary and your doctor will work with you to find the most appropriate dose and type. You may need to try couple before finding one that suits you.

What are the risks?

There has been a lot of research into HRT and its safety in general but not so much is known about the risks and the benefits after surgery for ovarian cancer. 

It is important to discuss the matter with your doctor and, if possible, get a referral to someone who specialises in dealing with women who are experiencing the menopause because of cancer treatment. Depending on your situation, you may decide to use HRT on a short-term basis for symptoms relief, for a longer-term basis for its health benefits, or not at all.

Vaginal oestrogen after surgical menopause

Vaginal oestrogen is given to treat vaginal changes after a surgical menopause and can be used alone or alongside conventional HRT. Vaginal oestrogen will not help other menopausal symptoms but is associated with fewer side effects and risks. It can be given via creams, vaginal tables or vaginal rings, all of which are effective at reducing vaginal dryness and sexual discomfort.  

Alternatives to HRT

If you choose not to use HRT or have a medical reason not to, other medications can be prescribed. Citalopram, paroxetine and venlafaxine are classed as antidepressant medicines but they have been found to help menopausal flushes and sweats when used at low doses. Clonidine is a blood pressure medicine that may help flushes. If you experience bone density loss later in life, you may be prescribed drugs to treat osteoporosis.

Cognitive behavioural therapy (CBT) has been proven to be a safe and effective treatment for women who experience menopausal symptoms such as hot flushes and night sweats with additional benefits to mood, sleep and quality of life. The CBT Register UK allows you to search for a therapist in your area or you can ask your GP for a referral.

There are lots of herbal and dietary supplements aimed at helping with the menopause. The evidence is inconsistent so you may wish to ask a pharmacist for advice as they can interfere with other medicines; these remedies may also contain oestrogen.

You can find out more about these alternatives on the NHS website.

How does menopause affect your emotions?

A surgical menopause changes your hormone levels which can affect how you feel. This is on top of the emotions that you may already be feeling relating to your diagnosis and treatment.

You may feel:

  • Too young to be going through the menopause
  • Worried about your options to have a baby
  • Less feminine
  • Worried about the future
 If this sounds familiar you may benefit from talking to your family and friends about how your feelings are affecting you and your relationships. It may also help to speak to a counsellor or with other women who have experienced the same. 

What about long-term health after menopause?

After a surgical menopause, you will be advised to take measures to ensure that you stay healthy in the years ahead. This will include protecting your bones from osteoporosis and maintaining a healthy heart.

Early menopause can increase the likelihood of developing osteoporosis or loss in bone density which, for some women, may lead to an increased risk of fractures. You should be offered a DEXA scan to assess the density or strength of your bones, which will help to predict your future risk of fracture.  

Where to go for advice and support

Menopause Matters is an independent website providing up-to-date, accurate information about the menopause, menopausal symptoms and treatment options.

Henpicked also contains lots of information about the menopause, including early and surgically-induced menopause. 

The Daisy Network has lots of useful information for younger women who are having issues with early menopause. 

You can also read Laura Moses’s experience of going through the menopause as a young woman.