Menopause after chemotherapy

Some cancer treatments stop the ovaries working. When that happens, menopause can follow, sometimes years or decades before it would have come on its own.

The Pakistan Menopause Society calls this induced menopause, and lists chemotherapy and radiation among its causes, alongside surgery to remove both ovaries. The NHS website adds certain hormone medicines to the list. Women's Health Concern, the patient arm of the British Menopause Society, names hormone therapy for cancer as another treatment that can bring changes on.

Your age at the time decides what it is called. Before 40, it is premature ovarian insufficiency. Between 40 and 44, it is early menopause. Both come with guidance of their own.

The NHS website lists the symptoms of early menopause: hot flushes and night sweats, vaginal dryness, difficulty sleeping, low mood or anxiety, a lower sex drive, and problems with memory or concentration.

After cancer treatment, those land on a body that is already exhausted. It can be hard to tell which tiredness belongs to the treatment and which to the menopause. Keeping a note of when each symptom started can help your doctors untangle it.

Women's Health Concern explains that during your fertile years, your ovaries produce estrogen. The Pakistan Menopause Society describes induced menopause as the loss of ovarian function brought about by treatment: the medicine or radiation stops the ovaries doing their job, and the estrogen they made falls with them.

This is specialist territory, and the guidance says so.

For most women whose menopause comes early, the NHS website says the usual approach is to replace the missing hormones, with the combined pill or HRT, because an early menopause raises the chance of problems with bones and heart. But the same page says women who have had certain types of breast cancer may not be able to have hormone treatment. NICE NG23 asks doctors to stop systemic HRT in women who are diagnosed with breast cancer (1.8.8). The Pakistan Menopause Society says women with hormone-sensitive cancers need individual specialist care.

NICE NG23 sets out what women in England with a history of breast cancer should be offered:

• information on every management option open to them, and referral to a professional with expertise in menopause (1.5.31)
• for vaginal dryness and other genitourinary symptoms, non-hormonal moisturisers or lubricants first (1.5.14)

What is right for you depends on your cancer, your treatment and your history. That decision belongs with your oncology team and a menopause specialist working together, not with a website.

Ideally, before treatment begins. NICE says the conversation about menopause and fertility should happen before treatment as well as after (1.2.6), and that you should be offered time with a fertility specialist and with someone who knows menopause (1.5.33 and 1.5.34). If no one has raised it, you can.

After treatment, see your doctor if menopause symptoms are affecting your sleep, your mood or your daily life, and ask about your bones and heart. The Pakistan Menopause Society lists severe depression and suicidal thoughts among the red flags that need evaluation or referral (section 2.3).

If you are looking for menopause care alongside cancer care, finding menopause care covers where to start in Pakistan and the Gulf.

A cancer diagnosis often brings the whole family into the room. That can be a comfort, and it can also mean the quieter questions, about fertility, about intimacy, about how your body feels now, never get asked. You can ask for a few minutes alone with your doctor for those.

Fertility can carry extra weight. If you are still hoping for children, or your family is, the question of freezing eggs before treatment may come up, and with it questions of faith. Women ask whether it is permitted and under what conditions, and they rarely get a clear answer in a clinic. That question belongs with a qualified scholar you trust. The medical question, whether there is time before treatment starts, belongs with your cancer team, and it is worth asking early.