Medically induced menopause

If you have cancer or cancer risk, you may need medical treatment or surgery that can bring on menopause. This is known as Medically Induced Menopause (MIM).  

Some treatments, such as chemotherapy, radiation or surgery (ovary removal), can cause temporary or permanent menopause. On this page you can find out what you need to know about medically induced menopause what you can do to manage symptoms and reduce health risks. 

What is medically induced menopause?

Medically induced menopause (MIM) is when menopause happens because of surgery or treatment, rather than naturally. For example, chemotherapy, or surgery to remove ovaries.  

MIM happens earlier than you would normally have gone through menopause and is the direct result of an operation or medicine. 

MIM is different to a natural early menopause (which occurs between age 40 and 45) or premature menopause (which occurs before age 40). These types of menopause happen earlier than the average age of 51, without medical treatment or surgery.  

It is also different to premature ovarian insufficiency (POI) when the ovaries work at a lower level before the age of 40. In POI, periods may stop or be irregular. The ovaries might work from time to time.

Is medically induced menopause the same as surgical menopause?

Medically induced menopause includes menopause because of treatment or surgery. There are lots of ways and words people use to describe having a medically induced menopause. The terms ‘medically induced menopause’ or ‘medical menopause’ are commonly used, but other terms include: 

• Treatment-induced menopause - menopause due to a treatment like a medicine that doesn’t involve surgery.  

• Chemically-induced or chemical menopause - some kind of medicine has been used by a person which triggers menopause 

• Surgical menopause - when menopause happens because of an operation 

• Early and premature menopause due to medical treatment - this is different to a natural early or premature menopause.  

• Induced menopause or forced menopause - when menopause has been caused early, at a point in a woman’s life that isn’t the natural time. 

Reasons for medically induced menopause

Are surgically induced menopause and treatment induced menopause the same?

Cancer treatments that can cause menopause

You might hear about people going through medically induced menopause after treatment for cancer.

Can chemotherapy cause medically induced menopause?

• Certain chemotherapy drugs can damage the ovaries and lead to medically induced menopause. Chemotherapy works by targeting and killing cells that divide quickly. This includes cancer cells but may also affect cells in your ovaries. 
  

Does radiation therapy cause medically induced menopause?

There are certain types of radiation therapy that are more likely to affect your ovaries and can cause MIM, including:

• Pelvic area radiation therapy. This could treat ovarian, uterine, bladder or bowel cancer, for example.   

• Radiation treatment for the head or brain can affect the pituitary gland. This gland tells your ovaries to make hormones such as oestrogen.

• Whole body radiation therapy.  

Do hormone treatments for breast cancer cause medically induced menopause?

• Some hormone medicines used to treat cancers or reduce recurrence, including some breast cancers, can cause MIM. Anti-oestrogen treatments affect the ovaries, and usually cause menopause symptoms. These include medicines such as tamoxifen, goserelin or aromatase inhibitors. 

Will cancer surgery cause medically induced menopause?

• Surgery to reduce your risk of an inherited cancer, or to treat cancer, may cause menopause. This will happen if both ovaries are removed. This can happen to treat or reduce the risk of ovarian cancer in women with a strong family history or gene mutations such as BRCA1, BRCA2 or Lynch Syndrome (to name a few). Sometimes it is recommended as part of breast cancer treatment.

Menopause after hysterectomy and oophorectomy

If you have both ovaries removed (double oophorectomy) as well as a hysterectomy you will have a medically induced, permanent menopause.  

If you still have one or both ovaries after your hysterectomy, you might have MIM. But you have a higher chance of a natural menopause than of MIM, though it may happen earlier than it would have without the surgery.

What to expect with medically induced menopause

How quickly can medically induced menopause happen?

This varies depending on the treatment or surgery you have had that triggers it – as well as your individual situation. It is often much faster than a natural menopause. This is because in a natural menopause you go through a phase called perimenopause – where hormone levels are changing but you still have periods. The perimenopause can last years for some women.  

In medically induced menopause you do not always get the same kind of perimenopause phase. Here’s what the latest research tells us about timings. 

• If you have both ovaries removed, menopause is immediate.

• Chemotherapy may trigger menopause symptoms right away or months after treatment. 

• Radiation therapy may cause medical menopause around 3 months after treatment – depending on the dose and place where you have the treatment.

• Hormone injections to treat conditions such as endometriosis or fibroids, can bring on menopause within a few weeks.

• A hysterectomy without ovary removal may lead to earlier menopause – for a small number that may be very quick, or a year or two. It may just happen earlier than your natural menopause would have done.

What are the symptoms of medically induced menopause?

The range of symptoms are the same as those in natural menopause. These can include: 

• hot flushes 

• night sweats 

• sleep problems 

• vaginal dryness, itching, irritation  

• lower sex drive 

• painful sex 

• leaking urine or having to wee more often 

• bladder, vaginal or urinary tract infections (UTIs) 

• mood changes 

Find out more about menopausal symptoms. 

Is MIM worse than natural menopause?

Everyone’s experience is different. MIM can be particularly challenging due to a number of key things: 

• MIM symptoms can come on suddenly, in line with a surgery or treatment:
  • This can make the experience more intense and feel like more of a shock.

• Some symptoms can be more severe: 

• • The sudden drop in oestrogen after ovary removal can make some symptoms more intense. This includes loss of sex drive and more severe sleep disturbances  

• • Women going through menopause due to breast cancer can have more severe symptoms. Research suggests 50-75% of young women going through menopause due to breast cancer treatment may particularly experience dry or itchy vagina, painful sex or UTIs. They may also be more likely to have depression and anxiety. 

• The emotional impact: 

• • If you are coming to terms with earlier and unexpected loss of fertility, or dealing with a diagnosis of cancer, it can add additional extra emotional distress. 
    

Are there long-term health risks from medically induced menopause?

Just as natural menopause increases some risks of health conditions, so does MIM. You may have a higher risk of these health conditions if MIM comes earlier than your natural menopause would have done. More research in this area is needed. 

This includes increased risks to:

• Heart and circulatory health - increased risk of high cholesterol and blood pressure 

• Bone health - increased risk of osteoporosis 

• Cognitive health - increased risk of memory problems

The good news is that there are lots of ways to decrease your risks – including considering Menopausal Hormone Therapy (MHT) (if able to) or other medicines, regular exercise, healthy eating, reducing alcohol intake and stopping smoking.

What treatments are there for MIM?

• Treatments from healthcare professionals:  

• • Menopausal hormone therapy (MHT) - is often recommended for MIM under the age of 45 (unless you have been diagnosed with a hormonal cancer, in which case you should check with your healthcare provider). You need to be sure it will not increase your risk of your condition returning if you have a hormonal cancer, endometriosis or fibroids, for example. It is crucial to talk to your doctor about your specific circumstances. The good news is that recent research shows some types of MHT may be suitable for some women, depending on individual circumstances and risks. 

• • Vaginal oestrogen - can help with vaginal dryness, itching, uncomfortable sex and other issues like needing to pee more often or urgently. These can be prescribed for women after breast cancer depending on individual circumstances. 

• • Non-hormonal medicines - are available to help ease symptoms such as hot flushes and night sweats.

• Lifestyle approaches - Regular exercise, a balanced diet, stress management, and enough quality sleep can help you manage menopause symptoms and look after your bones, heart, brain and vaginal health – which need more support the earlier your menopause takes place. 

• • Foods for menopause - phytoestrogens found in soy wholefoods, such as soy beans, tempeh, tofu or soy milk are considered safe for women after breast cancer.  

• • Dealing with vaginal dryness: 

• • • Non-hormonal vaginal moisturisers and lubricants - can help with vaginal dryness, uncomfortable sex and itching – including for women after breast cancer treatment.

• • • Sexual activity including masturbation - can improve blood flow to your vaginal tissues and ease dryness.

Is medically induced menopause temporary or permanent?

Can you know if medical menopause will be permanent?

Temporary menopause from hormone medicine

Injections to create a temporary menopause are key treatments for a wide range of conditions. They are called Gonadotrophin-releasing hormone (GnRH) analogue injections. They stop your ovaries making the hormones oestrogen and progesterone and stop your menstrual cycle.  
 
You may be prescribed GnRH injections to help manage symptoms of: 

• endometriosis 

• adenomyosis 

• uterine fibroids 

• heavy or long periods (menorrhagia) 

• pelvic pain 

• premenstrual dysphoric disorder (PMDD). 

GnRH injections: will menopausal symptoms stop after treatment?

• If you have not been through menopause, ovulation and periods usually come back within 6-10 weeks after stopping treatment with GnRH. 
• The longer you’ve been on treatment, the longer it might take for periods to return. 
• Oestrogen levels start to rise again after the last injection wears off. That means your menopausal symptoms might also improve. 
• The older you get while you take the treatment, the closer you get to your natural menopause. You may find you are in perimenopause when you stop treatment.  
• If you have been through natural menopause while taking the treatment, your periods will not come back. 

When can treatment induced menopause be temporary?

The following factors can make it more likely that you get back your periods and fertility after treatment such as chemotherapy. 

• Being aged under 35 - the younger you are, the more likely you are to have more eggs in your ovaries. One study suggested over 70% of women under 35 got their periods back – it reviewed women between ages 20 to 35 whose periods stopped during treatment. Some sources suggest women under 45 may get their periods back two years after treatment.

• The type and dose of chemotherapy drugs you have - some are less damaging to the ovaries (gonadotoxic) than others. Having the least damaging medicine types, lower doses and a lower number of medicines as part of your treatment can also increase the chance of chemotherapy menopause being temporary. 

• Your health condition - sometimes, lower doses are used for conditions including lupus and rheumatoid arthritis.

When can radiation therapy induced menopause temporary?

There are some things that make it more likely your menopause is temporary after radiation treatment. This includes: 

• Your age - the younger you are, the more egg cells you are likely to have in your ovaries – so even if some get damaged, there may be others that don’t.

• The dosexii and location of your radiation treatment -

• • How much radiation your ovaries absorb is important. Lower doses, and radiation directed further away from your ovaries can make it more likely for MIM to be temporary.

• • How much radiation your pituitary gland also absorbs is important. This gland is located in your brain and tells your ovaries to make oestrogen.

• Whether you can ‘move’ your ovaries before radiation treatment - sometimes it is possible to have minor surgery that moves ovaries further away from the area where you need radiation treatment. This may help reduce damage to your ovaries and prevent MIM or increase the chance it is temporary. The operation is called ovarian transposition.  

Surgery and MIM

Does ovary removal cause menopause?

• Surgical menopause means the removal of both your ovaries. If you have both ovaries removed you will experience permanent menopause immediately. 

Does hysterectomy cause menopause? 

• A hysterectomy is an operation to remove your uterus and does not necessarily include the removal of the ovaries. However sometimes ovary removal is recommended at the same time as a hysterectomy. If you have a hysterectomy and keep both ovaries, you are likely to reach menopause at the expected age. However, in some women, a hysterectomy even without ovary removal may still lead to earlier menopause.

Does hysterectomy with the removal of one ovary cause menopause?

• If you also have one ovary removed with your hysterectomy, you have a higher chance of a natural menopause. There is also a small risk that you may have an immediate menopause after your operation. You may also reach menopause earlier than you would have done without the operation. This may be because blood flow to your ovaries can be affected, or scarring can happen due to the operation.

Does having fallopian tubes removed cause menopause?

• More research on this area is needed, but one study suggested that having both fallopian tubes removed during a hysterectomy may increase your chance of menopausal symptoms one year after surgery. This operation is known as a bilateral salpingectomy.

Chemotherapy, radiation therapy and permanent menopause

Your individual circumstances will affect whether your chemotherapy or radiation treatment causes a permanent earlier menopause, and how soon after treatment it starts.  

Here are some key factors to consider and talk through with your health care team.  

• Your age when you have treatment - the older you are, the closer you are likely to be to your natural menopause. This means you have fewer eggs in your ovaries already.  The chance of medically induced menopause being permanent increases with age.  

• Having chemotherapy and radiation therapy - if you have chemotherapy as well as radiation therapy to the belly (abdomen), pelvis or whole body it is more likely to cause a permanent menopause. 

• The type and dose of chemotherapy drugs you have - taking medicines that are more damaging to the ovaries (gonadotoxic) than others, higher doses, or more than one medicine can also increase the chance of chemotherapy menopause being permanent. 

These chemotherapy medicines are more likely to cause permanent menopause:

• • Busulfan 

• • Carmustine 

• • Chlorambucil 

• • Cyclophosphamide 

• • Doxorubicin 

• • Lomustine 

• • Mechlorethamine 

• • Melphalan 

• • Procarbazine 

• The dose and location of your radiation treatment - higher doses and radiation directly to your ovaries or pituitary gland (a gland in your brain) is more likely to create permanent menopause.