At some point in every woman's life, her ovaries stop producing eggs and her levels of the hormones estrogen and progesterone decline. Over time, what used to be monthly periods start happening less frequently. This process is called perimenopause, or the menopausal transition. When you’ve stopped menstruating for one complete year, you are said to be “post-menopausal” and no longer able to get pregnant.
Most women go through menopause as a natural part of the aging process, right around age 51 on average — some sooner, some later. But if you’ve been diagnosed with breast cancer before menopause, some of your treatments could bring on menopause more quickly and more abruptly than you expected. This is called medical or surgical menopause, or induced menopause. For example:
- Certain chemotherapies and hormonal therapies can slow down or stop the functioning of the ovaries. This medical menopause may be temporary — that is, last while you’re in treatment and for some time afterwards, and then your periods return — or it may be permanent.
- Removal of the ovaries, which is recommended for some women, causes immediate permanent menopause. This is surgical menopause.
- Some other therapies don’t actually lead to menopause but instead cause menopause-like symptoms, such as hot flashes. These can affect you if you’re pre-menopausal at diagnosis. Or if you’ve already started menopause naturally, you may find that your symptoms worsen with certain breast cancer treatments.
- Finally, there’s also what’s called cold turkey menopause, a result of stopping the hormone replacement therapy (HRT) that some women use to treat natural menopause symptoms that are especially severe or bothersome. HRT isn’t recommended for women who’ve been diagnosed with breast cancer, or are at high risk for the disease, because research has found a link between HRT and breast cancer risk.
Medical, surgical, and “cold turkey” menopause cause a sudden and dramatic shift within the body —lowering hormone levels within days or weeks instead of years. Symptoms may come on more abruptly than they would with a more gradual, natural menopause. Although these symptoms can be uncomfortable for anyone, they can be particularly hard to deal with if you’re in your 20s, 30s or early 40s and now find yourself “feeling menopausal” a good 10 to 20 years before you expected. For younger women who have their ovaries removed, which reduces hormone levels literally overnight, menopausal symptoms can be particularly intense. Early menopause also can raise concerns about the longer-term effects of spending more years without estrogen, such as bone loss.
There are ways to manage symptoms and live more comfortably with menopause. Lifestyle changes (diet, exercise, smoking cessation, emotional support) may be just as important and effective as medications in helping you feel better and live well. In this section, you can learn more about:
- Understanding the Types of Menopause
- Treating Menopausal Symptoms
- Hormone Replacement Therapy
- Long-Term Health Concerns After Menopause
Permanent menopause signals the end of fertility. If you’re premenopausal and still interested in having biological children, visit our section on Fertility and Pregnancy Issues.
The medical expert for Managing Menopausal Symptoms is Lynn Wang, M.D., gynecologist, Lankenau Hospital, Main Line Health System, Wynnewood, PA.
“Menopause is a wake-up call to a new phase of your life, and so is breast cancer. Two wake-up calls can be more than most people can handle, but what's the choice? You sure can't go back to sleep. So get up and decide what you're doing today — and on into the years ahead.”
-- Marisa Weiss, M.D., Breastcancer.org president and founder, breast radiation oncologist