Chemical menopause sounds like a scary phrase, especially if you’ve just been diagnosed with breast cancer. But what is it exactly, and how will it affect you? Here’s what you need to know.
What is chemical menopause?
Simply put, chemical menopause (also known as induced menopause) is when the ovaries stop producing sex hormones for a short stretch of time. This often happens during or after someone has had treatment for endometriosis or cancer treatments like chemotherapy and radiation. Unfortunately, chemotherapy-induced chemical menopause can cause symptoms that are worse for women than for those who experienced a natural menopause.
In some cases, chemical menopause can be reversible. But in others, it can bring on early (and permanent) menopause.
How does this happen?
While there are quite a few reasons why someone would go through chemical menopause, one of the main causes is chemotherapy.
Chemotherapy targets any rapidly growing cells in order to combat cancer. Regardless of the type of cancer they have been diagnosed with, women undergoing chemotherapy run the risk of their ovaries being attacked by the drugs too. As doctors have noted, chemotherapy can help put the ovaries to “sleep”, which causes a woman to enter a temporary menopause.
In some cases, menstruation will resume on its own between two and six months after chemotherapy ends. But for some women, going through temporary menopause during treatment can mean they enter the menopause sooner. And, if you were already approaching menopause, chemotherapy may induce complete menopause.
Is it reversible?
Yes and no. It all depends on the patient, their age, and where they were at in their reproductive journey. In some cases, you can start taking hormone therapy after chemotherapy in order to stop chemical menopause. In other cases, it may be permanent.
If this is something you’re concerned about, we recommend talking to your doctors as soon as possible about fertility after chemotherapy, hormone therapy, and what you’d like to do if permanent menopause is a possibility.
Potential Symptoms
Now that you know what chemical menopause is and how it all happens, let’s talk about some symptoms that you should be aware of so you can inform your doctor if they happen.
Hot Flashes
The first, and most common, symptom of menopause is hot flashes. Spicy foods, coffee, alcohol, tight clothing, heat, and stress are among the main triggers that cause hot flashes.
While they’re usually worse at night, there are a few easy things you can do to help ease the discomfort. These include taking a warm — not hot — bath or shower before bed, dressing in cotton pajamas, and using a fan to help you sleep.
You can also eat foods that have been shown to help some women with their hot flashes; including soy products and flaxseeds/flaxseed oil. Daily aerobic exercise can also help lessen hot flashes. We recommend around 20 minutes a day at least 3 days a week. This can be as simple as a walk or even dipping in a pool. In some cases, prescription drugs such as venlafaxine (Effexor) can also be helpful to certain women. It can lessen the frequency and intensity of hot flashes when taken in small doses.
Sleep Problems
Another common symptom is sleeping problems, specifically insomnia. While you may be able to take medication to help with this, some other tips that may help avoid it are:
- Only go to bed when you’re tired and ready to sleep.
- Regardless of whether you had a restful night’s sleep or not, rise at the same time each day.
- If you are having trouble falling asleep, get out of bed, move to another room, and return to bed only when you’re tired.
- Don’t stay in bed for longer than fifteen minutes.
- If at all possible, avoid using sleeping pills, but if you must, make sure to only take them as directed.
- Steer clear of foods high in caffeine.
- Steer clear of alcohol and nicotine, especially at night.
- Keep up a consistent physical activity routine.
Decreased Sex Drive
Menopause can effect sexual desire and function brought on by low levels of estrogen and testosterone. It’s typical to have less libido, or sex drive when going through chemical menopause as well.
During sexual activity, vaginal dryness frequently results in pain, vaginal discharge, and irritation. To lessen pain during sexual activity, consider using a water-based vaginal lubricant like K-Y Jelly or Astroglide. Of course, if you have any questions about how to use these products, speak with your physician or nurse. If you’re having difficulties that over the counter options can’t solve, talk to your doctor about prescription-only products, like topical ointments with low doses of testosterone or very low doses of estrogen.
Mood Changes
Mood changes like depression, anxiety, and even just irritability are common while going through menopause. Of course, things like a health diet, regular exercise, meditation, and breathing techniques can help. But if you find yourself slipping or feeling worse in your mental health, please talk to a professional. There are medications and therapy options that can help.
Memory Issues
Memory problems are fairly common as you get older, but they tend to be more prevalent during menopause. If you’re having trouble with working memory or short-term memory, you can try:
- Creating to-do lists
- Maintaining a set schedule
- Setting aside specific areas to hold your necessities (wallets, glasses, keys, etc)
- Keeping up with nutrition and daily exercise
Joint Pain
Both chemotherapy and menopause can cause joint pain, and taking aromatase inhibitors like anastrozole, letrozole, or exemestane can make your pains worse.
However, there are a few things you can do to ease joint pain, like:
- Gentle, low-impact exercise, like hydrotherapy (working out in a heated pool) and yoga.
- Acupuncture and over-the-counter options like ibuprofen (note: if you are receiving chemotherapy, consult your oncologist before taking any anti-inflammatory medications).
- Taking supplements containing fish oil or flaxseed oil.
Changes to Skin and Hair
Dry hair and skin are common physical changes that can happen. Unfortunately, there isn’t much you can do with these changes permanently since there isn’t really any medication you can take to help combat the effects. However, there are a few options that can help lessen the brittleness and flakes.
- Make sure to moisturize at least once or twice a day. Use options shea butter, hyaluronic acid, and lactic acid to help trap in moisture.
- Take supplements like biotin, collagen, vitamin C, and keratin to keep your hair and nails strong. Also, be sure to test for potential low iron levels. An iron supplement can help with hair brittleness.
- Stay hydrated, and try to drink at least 8-10 (8 oz) glasses of water per day. You can also eat high water content fruits and vegetables, like watermelon, cucumber, and celery.
- Avoid hot showers. Warm and slightly cool showers are best because they won’t strip your skin of moisture.
Osteoporosis
Every year after menopause, a woman’s bone density decreases. Osteopenia or osteoporosis could develop if your bone density decreases too much.
If you smoke, are very thin, are of Asian descent, have a family history of osteoporosis, or have gone through an early menopause, your risk of developing osteopenia and osteoporosis is increased.
Bone mineral density may also be decreased by certain breast cancer treatments.
However, there are steps you can take to lower your chance of getting osteoporosis, including:
- Engaging in 30 minutes of weight-bearing activity, such as dancing, jogging, or walking, three days a week.
- Adequate consumption of Calcium and Vitamin D.
- Giving up smoking and drinking less alcohol.
While there may be other symptoms, like heart palpitations and potential blood pressure issues, those symptoms tend to be less common. No matter what, we recommend letting your team know about any changes in your mental or physical health as soon as possible.
How to Manage Chemical Menopause
While going through chemical menopause, there are a few things you can do to help manage the symptoms and feel better. These include;
- Regular exercise, at least 3-5 days a week
- Quitting smoking and drinking as much as possible
- Curbing stress — this can include therapy, meditation, regular massages, etc
- Staying away from coffee, tea, and caffeine beverages, which may trigger hot flashes
- Sleeping regularly and for as long as possible (at least 7 hours uninterrupted each night)
- Starting hormone replacement therapy if recommended by your doctor
There are also specific medications that can help with other symptoms that are common with chemical menopause, and your doctor can discuss your best options with you.
What about fertility?
For some women, fertility issues are temporary and your long-term fertility won’t be affected by chemotherapy or radiation. However, in some cases, fertility issues can arise.
If you think that starting a family is something you’d want to do, or if you’d like to have more children after your treatment, there are a few things that you need to keep in mind.
First, many providers recommend waiting at least six months after chemotherapy before you start trying to get pregnant. If your cancer type has a high chance of reoccurrence, your recommended time frame is around two to five years. Please consult a fertility specialist and your cancer care team before attempting to conceive if you are taking medication to reduce your chance of a recurrence.
There are additional ways that cancer treatments may impact a subsequent pregnancy. Radiation therapy may harm your uterus’s blood supply and supporting cells. This may raise your risk of low birth weight, early delivery, miscarriage, and other issues.
Your chances of miscarriage or an early birth may also increase if all or part of your cervix is removed. This is due to the possibility that your cervix may be incapable of supporting a full pregnancy.
Certain chemotherapy drugs have the potential to weaken your heart and harm heart cells. If you also received radiation treatment to your chest or stomach, the likelihood of this damage increases. Due to the increased heart effort during pregnancy, these treatments raise the risk of cardiac issues.
Even with these potential risks, it’s still possible to have a baby after chemical menopause and cancer treatments. However, there are a few other things to consider.
Potential Fertility Treatments and Preparation
Outside of the common hormone replacement therapy, there are two other potential fertility treatments you can try after cancer treatment.
The first option is egg cryopreservation. This involves surgically removing and freezing eggs for later fertilization. This is also known as egg banking or egg freezing. If any treatment you go through can result in infertility, it can be helpful to freeze your eggs beforehand if you wish to become a parent. Your doctor may advise freezing eggs as soon as possible after your diagnosis, before you begin treatment, if you are single. The eggs are perpetually freezer-safe.
The alternative is embryo cryopreservation, which is the freezing of embryos for later use. It is also referred to as embryo freezing or embryo banking. This involved the process of in vitro fertilization (IVF), in which sperm and eggs are combined in a lab to create embryos after the eggs are extracted from the ovaries of women. After that, the embryos are put in a unique solution that contains cryoprotectants, which aid in the extraction of water from the embryo and shield the cells from damage caused by ice crystals. They are then frozen until they are needed.
Of course, we always recommend talking to your doctor before trying either of these options, but they’re common for women who plan on going through cancer treatment.
It’s also important to remember that there are many other ways to become a parent. These include surrogacy, adoption, fostering, and more. There are many women who have become parents after cancer treatments and chemical menopause, and they document their journeys so you don’t feel alone.
Chemical Menopause Isn’t The End
Yes, chemical menopause can be scary, especially when you’re already dealing with cancer treatment. But it’s not the end, and there are many ways to manage the symptoms, receive support, and keep up on your fertility journey if you choose.Health care and science have come a long way, and we hope they continue to make strides to support women going through treatment!
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