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Induced/Surgical menopause

When the ovaries are removed, or stopped from working by a medical treatment women have what is called an 'induced' menopause. It's more common than you might think. This explains the basics of what an induced menopause is, when it might happen and why this type of menopause can be particularly hard.

What is induced menopause?

(Also known as surgical menopause or iatrogenic menopause)

Surgical menopause is when periods stop after the removal of both ovaries in a surgery; or when the ovaries stop working due to some medical treatments. The ovaries make the hormone oestrogen. So when they are removed (surgical) or stopped from working (induced) oestrogen drops and causes menopausal symptoms.

When does it happen?

1. Treatment for ovarian cancer or cysts
Treatment for ovarian cancers, or non-cancerous ovarian cysts are the most common causes of surgical menopause. One or both ovaries will be removed to reduce the risk of future tumour growth.

2. Hormone treatments for other cancers
Some cancer treatments block hormones. This is because hormones can cause cancer cells to grow faster - so blocking them can slow the growth of cancerous cells.
The hormone therapies tamoxifen, anastrozole (Arimidex), letrozole (Femara) and exemestane (Aromasin) can all cause menopausal symptoms.

3. Chemotherapy
Sometimes chemotherapy treatment for cancer can impact how the ovaries work. This can cause periods to stop, and therefore oestrogen levels to drop. If you haven't been through natural menopause, periods will often come back after chemotherapy is stopped.

4. After some types of hysterectomy
If you have a hysterectomy where the ovaries are removed, or a radical hysterectomy to treat some types of cervical cancer then you'll experience the menopause immediately after the operation. This happens regardless of your age, and is another common type of surgical menopause. If you have a hysterectomy where one or both ovaries are left in tact, you still have an increased risk of menopause after 5 years. If you're due to have a hysterectomy, or have had one recently and are experiencing treatments your doctor should advise you on the best ways to reduce your symptoms.

What are the symptoms?

The symptoms of induced menopause can be more extreme than in "natural menopause" because these treatments cause oestrogen levels to drop drastically over a number of days. This sharp fall often triggers severe menopause symptoms, including:

  • Hot flushes and night sweats
  • Sleep problems
  • Low mood
  • Lack of energy
  • Joint pain
  • Anxiety
  • Low libido
  • Vaginal dryness.

What are the treatments?

If you've experienced a surgical menopause your doctors may recommend hormone replacment therapy (HRT). HRT should help ease symptoms, once you find the right dose. It also protects you against the long term risks of osteoporosis and heart disease. The type of HRT that you'll be advised to take will depend on your medical history and your symptoms.

If your menopause was induced by cancer treatment you may not be eligible for HRT. This is because HRT can increase the risk of some cancers. Having said that, some women will still want to try HRT as the benefits of the hormones will outweigh the risks. This decision is ultimately down to each indivdual woman.

Your doctor should explain the risks and benefits to you to make sure you have all the information you need to make your own treatment decisions. This process of information sharing should always involve a doctor presenting alternative treatments such as cognitive behavioural therapy and some other medications (e.g. gabapentin for hot flushes).

As with all menopausal symptoms - lifestyle changes can help with symptoms management and reducing triggers. This includes changes to diet and exercise. Find out more about lifestyle changes here.

References:

  1. Hillard T., et al. (2017). Management of the menopause. 6th edn. British Menopause Society. UK.
  2. National Health Services (2019). Hysterectomy. Considerations Retrieved 15 February 2020 from [https://www.nhs.uk/conditions/hysterectomy/considerations/]
  3. National Health Services (2019). Overview. Menopause Retrieved 15 February 2020 from [https://www.nhs.uk/conditions/menopause/]