Menopause is defined by the natural cessation of the menstrual cycle and the ability to conceive a child. The whole process (from perimenopause to postmenopause) can take years to complete. However, for some women undergoing cancer treatment, menopause occurs in a single day or several weeks because of surgery, chemotherapy, or pelvic radiation therapy. This is called surgical or forced menopause and can be either a permanent or temporary side effect of treatment.
Key Points
Why Forced Menopause Can Occur with Cancer Treatment
The ovaries serve as a major hormone production center for estrogen and progesterone, two essential hormones that support the menstrual cycle and fertility. Cancer treatment can impair the function of the ovaries. Women undergoing a total hysterectomy or bilateral oophorectomy to treat gynecological cancer undergo immediate surgical menopause.
The ovaries are removed, and there is an immediate decrease in hormone levels in the body. Chemotherapy can damage the ovaries, leading to a permanent or temporary menopause. This can cause a woman’s period to stop for several months, even after treatment has ended. Some women are surprised to find their period returning months after treatment, so it is important to use a birth control method until you know for certain that you are post-menopausal.
Radiation therapy to the pelvis is also a source of forced menopause. The effects can be permanent or temporary, depending on the treatment regimen. Like chemotherapy, radiation therapy causes damage to the ovaries, limiting their function.
Physical Changes That Occur with Forced Menopause
Diminished hormone levels in the body can cause many physical and emotional changes. Women who undergo sudden menopause because of cancer treatment (especially surgical menopause) sometimes experience these effects more intensely than women who undergo menopause naturally.
Effects of Menopause
- Hot flashes
- Night sweats
- Mood swings
- Depression
- Vaginal dryness
- Low libido
Hot flashes and night sweats can be the most common and the most bothersome. Some women may be given hormone replacement therapy (HRT) to relieve these symptoms, but HRT is not for all women. You should discuss the risks and benefits of taking hormone replacement therapy with your doctor.
Before taking any over-the-counter (OTC) menopause remedies or herbs, talk to your doctor.
Some OTC products may interfere with your cancer treatment.
Menopause and Mood
Have you suddenly begun crying during sad commercials?
Snapping at your teenagers when you used to be calm? Had a meltdown during a staff meeting, seemingly out of nowhere? As many as a third of women will complain of some sort of mood problem during the menopause years, and these changes can begin as early as your thirties.
There are several ways that your mood can be affected by the hormone changes and other events around menopause, and nothing will make you burst into tears faster than someone who dismisses it as “all in your head.” You know it’s not in your head, although it can feel a little crazy sometimes. Understanding why can help you cope, and it also gives you a way to explain it to your less-than-sympathetic family or colleagues.
A number of forces converge during midlife to shake your emotional equilibrium, and some women are more vulnerable than others. If you are one of the women suffering from mood shifts, there may be an underlying clinical reason for it, and there are treatments and solutions that can help. Pay attention to the nature of your mood problems and see whether one of the following could be at the root of your emotional symptoms:
Hormone Sensitivity
Some women are just more sensitive to hormone changes than other women. Although only about 8% to 10% of women fall into this “super sensitive” category, it can be pretty unnerving to be easily thrown by
small hormone changes.
Some signs that you might be a member of this group are:
- You have suffered from premenstrual symptoms in the past
- You noticed that you were emotionally up and down during a pregnancy
- You have had a postpartum depression
Any of these could be a warning that a change in estrogen levels is likely to throw you for a loop more than other women your age. Estrogen plays a major role in how neurotransmitters -– chemicals that affect
brain and nerve function -– operate. This, in turn, can affect your mood and behavior.
If you fall into this category, discuss the hormone treatment options with your medical provider and see whether a short course of hormone therapy would help smooth out the mood roller coaster.
Recent Cancer Treatment or Surgery to Remove Your Ovaries
As with the hormone sensitive group mentioned above, women who have had their ovaries removed or whose ovaries have stopped functioning as a result of medical treatments may notice the impact of low estrogen. Because the shift is rapid—from normal levels of estrogen to very low levels—the effect on neurotransmitters can be quite dramatic, causing serious mood problems or instability.
Treatment for sudden loss of estrogen depends on the cause. There are hormone therapies and selective estrogen receptor modulator (SERM) medications that may be very useful to you during this time. This is definitely a topic for you and your medical provider to explore. If you are anticipating surgical removal of your ovaries or a medical treatment that affects them (such as chemotherapy), talk to your doctor ahead of time to minimize your symptoms.
Sleep Deprivation
Women who have a lifestyle that cuts sleep time short, or who are having vasomotor symptoms like hot flashes and night sweats, are likely to be suffering from some form of mood problem caused by sleep deprivation. After 40, your chances of having a sleep disturbance rise.
Sleep disturbance or a sleep disorder changes your mood -– and not in a good way.
If any of the following are true for you, you might be suffering from sleep deprivation:
- You wake up at night with night sweats. Even if your night sweats are mild, they can keep you from getting deep, restorative sleep. You might think you are getting 8 hours of sleep a night, but if you never get down into deep sleep, you could still be suffering sleep deprivation.
- You regularly get fewer than 7 hours of sleep a night.
We have a culture that worships productivity,” and going without sleep is often a badge of honor. But the truth is that we are less productive and will have problems with memory and concentration if we ignore the need for sleep. Finding a way to get enough sleep could boost your effectiveness in ways that will surprise you. - You wake up thinking about problems.
Stress is a major reason for sleep loss, so learning stress management techniques, and ways to fall back asleep, can give you more emotional stability to cope with life’s challenges. - Your partner tells you that you snore.
Snoring could be a symptom of sleep apnea. If you are a snorer and are tired during the day (like night sweats, sleep apnea can prevent that lovely, restorative sleep), it is probably time for a sleep study to see if you need treatment. Weight gain and age can contribute to sleep apnea, too, so midlife is a common time to develop this condition.
Sleep deprivation or a sleep disorder can cause irritability, anxiety and even depression if it goes on for long. If midlife is cutting into your sleep, or the quality of your sleep, it can affect your mood.
A History of Depression
If you have a history of major depression, you are more likely to suffer from mood problems during your menopausal years. If you have been on antidepressants in the past or have been diagnosed with a depressive disorder, the menopause years may bring another bout of depression. If you notice that your mood is suffering again, get help as soon as you notice it so that the depression doesn’t get a head start.
