Menopause and Menopausal Symptoms
Menopause marks the point in a woman’s life when she stops having periods. You are considered officially menopausal once you have gone 12 months without a period. Menopause is natural and occurs as part of the aging process. You may start to feel symptoms such as hot flashes in the years leading up to menopause. This transition period is called peri-menopause or the menopausal transition. Peri-menopause starts an average of four years before your final menstrual period, but may start as early as eight years before your final period.
Menopause usually starts in your mid 40s to 50s as a natural part of aging, with the average age of menopause being 51. But if you’ve been diagnosed with breast cancer, it’s important to know that some treatments can bring on menopause early and suddenly (called induced menopause).
Everyone experiences menopause a little differently. Sometimes the symptoms are mild and the transition is smooth. For other women, the symptoms can be very bothersome and the transition more intense. Your experience may depend in part on how quickly you move from peri-menopause to menopause, and whether you have any other health conditions.
Some women welcome the end of monthly periods and not having to think about birth control. Other women feel a sense of grief over what they see as the loss of fertility and their youth. Younger women may find it hard to think of themselves as menopausal when menopause is the result of breast cancer treatment.
There is no right or wrong way to think about menopause. What’s important is keeping your physical and mental health the best it can be.
Stages of menopause
The process of menopause occurs in three stages: Peri-menopause, menopause, and post-menopause.
In your preteen or early teen years, your ovaries begin producing the hormones estrogen, progesterone, and testosterone. Soon after that, an egg is released from an ovary about every month (ovulation), followed by a menstrual period if the egg isn’t fertilized.
From the time your periods start until your 40s, your estrogen and progesterone levels regularly rise and fall, triggering monthly ovulation and periods.
At some point in your 30s or 40s, things start to change. As your ovaries age, they may not release an egg every month. Estrogen and progesterone levels rise and fall less regularly. Your periods may be irregular. They may be heavier, lighter, more frequent, or less frequent. This is peri-menopause.
You may start to have some menopausal symptoms, including hot flashes, vaginal dryness or atrophy, trouble sleeping, and mood swings. The length of peri-menopause is different for each woman. The average length is about four years, but it can last for up to 14 years in some women. Other medical conditions and habits like smoking can influence how long this transition period lasts. During peri-menopause, it is still possible to get pregnant even though your periods may be irregular.
In menopause, your estrogen and progesterone levels are consistently low and your ovaries no longer release eggs.
Menopause is diagnosed when you haven’t had a period for 12 months in a row. If you skip eight or nine months and then have a period, you’re still considered to be in peri-menopause.
You’ll likely have some menopausal symptoms, which may include hot flashes, trouble sleeping, fatigue, irritability, depression, weight gain, and word-finding and memory problems.
Once you’ve stopped having periods for 12 months straight, you are post-menopausal. When it occurs naturally, the transition between menopause and post-menopause itself is instant, like stepping through a doorway.
For some women, menopausal symptoms may go away a year or two after they are considered post-menopausal. For other women, symptoms such as hot flashes and vaginal dryness may linger.
Types of menopause
There are three broad categories of menopause.
Natural menopause happens as part of the aging process.
Medical menopause, or medically-induced menopause, happens when the ovaries:
are surgically removed — called surgical menopause
are shut down with medicine, such as Lupron (chemical name: leuprolide) or Zoladex (chemical name: goserelin) — called medical menopause
stop working because of chemotherapy, hormonal therapy, or another type of treatment for a medical condition
With any form of medical menopause, the ovaries stop functioning and your estrogen and progesterone levels drop quickly and dramatically. Medically-induced menopause often causes more intense and troubling side effects, especially if you’re younger.
“Cold turkey” menopause is a combination of natural and induced menopause. If you were taking hormone replacement therapy (HRT) and had to stop because you were diagnosed with breast cancer, this may have happened to you. Cold turkey menopause is the result of the dramatic drop in estrogen that happens when you suddenly stop HRT.
No matter what type of menopause you experience, you’ll want to know how to manage any troubling symptoms including hot flashes, weight gain, vaginal changes, mood swings, and feeling tired. You’ll also want to take steps to prevent post-menopausal health concerns, such as osteoporosis and heart problems.
In addition to treating individual menopausal symptoms, a healthy diet, regular exercise, and keeping stress under control can help boost your state of mind and your overall health.
Testing for menopause
When it occurs naturally, not having a period for 12 months means you’re in menopause. If breast cancer treatments have caused menopause, there are some tests that can help you and your doctor track what’s happening.
Learn more about tests to determine menopausal status.
How menopause can happen with breast cancer treatments
Certain breast cancer treatments can cause induced menopause. Treatment-induced menopause is usually more sudden and the symptoms are more severe than when menopause happens naturally.
Chemotherapy destroys cells that divide quickly, like cancer cells. The ovaries also contain rapidly dividing cells, which also are affected by chemotherapy. This is why chemotherapy can bring on menopause.
Certain chemotherapy drugs are more likely to cause menopause than others. Chemotherapy regimens that use Cytoxan (chemical name: cyclophosphamide) commonly cause menopause, though it’s possible for any chemotherapy regimen to do so.
Targeted therapies, such as Herceptin (chemical name: trastuzumab), are often given along with chemotherapy. These medicines target specific features of cancer cells, such as HER2 proteins. It’s important to discuss all the medicines recommended for you with your doctor. Many targeted therapies have a low risk of harming the ovaries.
How quickly the ovaries recover after chemotherapy depends on how old you are and the types and doses of medicines you receive. Chemotherapy-induced menopause may be permanent. The older you are, the higher the risk that menopause will be permanent. It’s important to talk to your doctor about steps you may be able to take to preserve your fertility before you start treatment.
Women who have a genetic mutation that is linked to a much higher risk of breast cancer may choose to have their ovaries surgically removed. This is called bilateral ovary removal, prophylactic ovary removal, or prophylactic oophorectomy.
“Bilateral” means both sides or both ovaries. “Prophylactic” means preventive.
Surgery to remove the ovaries causes immediate and permanent menopause. The side effects from surgical menopause, including hot flashes and mood swings, can sometimes be intense because menopause literally happens overnight.
Ovarian shutdown, also called ovarian suppression, happens when medicine is used to temporarily stop the ovaries from working. Your doctor may recommend ovarian shutdown if you’re pre-menopausal during breast cancer treatment and may want to have children in the future.
Ovarian suppression during chemotherapy helps protect your ovaries from early ovarian failure, which is a cause of infertility.
Doctors also use ovarian suppression to help make certain cancer medicines more effective or to help reduce the risk of recurrence (the cancer coming back).
Medicines that cause ovarian shutdown are called luteinizing hormone-releasing hormone (LHRH) agonists. They include Zoladex (chemical name: goserelin) and Lupron (chemical name: leuprolide). These medicines are given as injections once a month for several months or every few months. Once you stop receiving the medicine, the ovaries usually begin functioning again. The time it takes for the ovaries to recover varies from woman to woman.
Hormonal therapy medicines, also called anti-estrogen therapy, endocrine therapy, or hormone therapy, treat hormone receptor-positive breast cancer by lowering estrogen levels in your body or by blocking the effects of estrogen on breast cancer cells. Hormonal therapy medicines don’t actually cause menopause, but, because of how they work, you’re likely to have some menopausal symptoms while you’re taking them.
Tamoxifen and other selective estrogen-receptor modulators (SERMs) can cause menopausal symptoms such as hot flashes, night sweats, vaginal discharge, and mood swings. Tamoxifen may be recommended for both pre-menopausal and post-menopausal women. Tamoxifen tends to have fewer sexual side effects than aromatase inhibitors because it doesn’t change the level of estrogen in your body. It works by blocking estrogen from stimulating certain cells to grow and multiply.
Aromatase inhibitors are mainly prescribed for post-menopausal women or pre-menopausal women who have had their ovaries shut down with medicine.
The aromatase inhibitors are: Arimidex (chemical name: anastrozole), Aromasin (chemical name: exemestane), and Femara (chemical name: letrozole).
They can make any menopausal symptoms you’re already having, such as hot flashes and fatigue, worse. Aromatase inhibitors also can cause bone and joint pain.
Selective estrogen receptor downregulators (SERDs), such as Faslodex (chemical name: fulvestrant) and Orserdu (chemical name: elacestrant) also can cause menopausal symptoms such as hot flashes and fatigue.
Menopausal symptoms
For some women the symptoms of menopause are mild. For other women, the symptoms can be severe and very troubling. In most cases, menopausal symptoms are caused by a drop in estrogen levels. Lower estrogen levels have an effect on your hypothalamus, the part of the brain that controls your appetite, sleep cycle, sex drive, and body temperature.
Some of the most common menopausal symptoms are:
Hot flashes and night sweats: The drop in estrogen can confuse the hypothalamus so it thinks your body is too hot. Your body reacts by opening blood vessels in the skin, which releases sweat to cool you off; this is a hot flash. When hot flashes happen at night, they are called night sweats. The North American Menopause Society recommends exercise, medicines, nerve blocks, and cognitive behavioral therapy to ease hot flashes.
Vaginal and urinary changes: These changes may include thinning of the vaginal walls (which used to be called vaginal atrophy by doctors), vaginal dryness, vaginal discharge, as well as incontinence (the inability to hold your urine), needing to pee more often, urinary tract infections (UTIs), and bladder infections. These happen because the vagina, bladder, and urethra (the tube that lets urine move from your bladder and out of your body) all require estrogen to function properly. Doctors now call this constellation of symptoms genitourinary syndrome of menopause (GSM).
Low-dose vaginal estrogen or vaginal DHEA (dehydroepiandrosterone, also called prasterone), a steroid, can help ease a number of these symptoms. Most women with a history of breast cancer can safely use these products, as long as they are prescribed by a doctor and used under a doctor’s supervision.
Loss of libido: The drop in estrogen that comes with menopause also might lower your desire for sex and intimacy – your libido. Low sex drive can be difficult to define, but if it’s bothering you, definitely bring it up with your doctor. This can be common in women who go into sudden, early menopause because of breast cancer treatment. Other menopausal side effects, including some vaginal dryness, which can make sex painful, and fatigue, also can contribute to a lower sex drive. Treatments depend on what caused the loss of libido and should be tailored to each woman’s needs. Certain medicines, exercises, and vaginal lubricants may help.
Mood swings: Some women find their feelings all over the place during peri-menopause and menopause. You may feel extremely happy one minute and then snap at your family over something small the next. These emotional changes happen because hormonal changes in your body affect the chemistry of your brain and are a natural part of menopause. There are ways to put yourself on a more even keel, including exercise, therapy, and acupuncture.
Menopausal weight gain: As women get older and go through menopause, they often gain weight. Some women lose muscle and gain fat, so while the number on the scale stays the same, they feel like they weigh more. If you’re being treated for breast cancer, you may be in pain, fatigued, stressed, depressed, and less active, all of which can contribute to weight gain. It’s important to know that gaining weight during breast cancer treatment increases the risk of recurrence. Exercise and diet changes can help you lose weight, as can managing other side effects.
Menopausal sleep problems: While it’s not clear how lower estrogen levels affect your sleep cycle, we do know that menopausal symptoms like hot flashes and night sweats can disrupt your sleep. Post-menopausal women are also more likely to have sleep apnea, when you temporarily stop breathing while you’re sleeping. You might snore loudly, wake up a lot during the night, or feel very tired during the day if you have sleep apnea. Studies show that about one in five women will develop sleep apnea during menopause, so talk to your doctor if you or your partner notice symptoms. Learn more about insomnia and things you can do to get better quality sleep.
Menopausal skin changes: As you move through menopause your skin may feel drier, itchier, thinner, and much more sensitive. At the same time, you might notice pimples and teen-age acne. Changing hormone levels are the reason behind all these issues.
Menopausal hair changes: Your hair texture may change as you move into menopause. It may seem more brittle and frizzy or it may get thinner.
Menopausal memory and concentration problems: Menopause can make you feel fuzzy mentally or like you can’t remember things or concentrate as well as you once did. It’s not clear how much of this is menopause and how much is a result of getting older. There are also a number of breast cancer treatments, including hormonal therapy and chemotherapy, that can cause problems thinking and remembering, For example, people receiving chemotherapy often complain about “chemo brain” or “chemo fog.” There are steps you can take to manage memory loss and concentration problems, including staying physically and mentally active, staying organized, and sleeping well. Listening to music every day also has been shown to help improve cognitive function in people who’ve been treated for breast cancer.
Irregular periods: Before your periods stop completely, you may have a period one month and then skip several months before the next one. Your periods may also be lighter or heavier than usual.
Menopausal grieving and depression: Besides mood swings, you may feel a sense of grief or deep sadness as you move through menopause.
Post-menopausal health concerns
Once you’re post-menopausal, keeping your bones and heart as healthy as possible is very important.
Estrogen plays a key role in keeping your bones, heart, and blood vessels working well. When estrogen levels drop after menopause, it’s important to take steps to keep your bones and heart strong.
You also may experience post-menopausal weight gain or vaginal changes that affect your sexual health.
Learn more about post-menopausal health concerns.
— Last updated on August 7, 2025 at 7:47 PM