Telling women that cancer or medical treatment may cause early menopause: Health Practitioners’ perspectives

Early menopause (EM) can occur in women under 45 years of age due to medical treatments including chemotherapy, radiotherapy, oophorectomy, or following hysterectomy (in some cases). Women may have their ovaries or uterus surgically removed as part of cancer treatment, to reduce their cancer risk, or to treat conditions such as endometriosis. Treatment with gonadotrophin-releasing hormone (GnRH) agonist which cause ovarian suppression may also cause menopausal symptoms (see Symptoms of early menopause) and stop menstrual periods but as the effects are reversible it is not considered EM. GnRH agonists are used to treat endometriosis, for women with oestrogen positive breast cancer in combination with aromatase inhibitors or tamoxifen, or to protect the ovaries from the effects of chemotherapy

Health practitioners remarked that women’s experience of medically-induced EM depends on their medical and personal circumstances. Some noted that while women’s reactions to medically-induced EM can vary, it is important to offer psychological support.

Dr Barker, a general practitioner based in a regional town, discussed the psychological counselling needed by women diagnosed with EM.

Medically-induced EM for non-cancer causes

EM can be caused by having an oophorectomy or in some cases a hysterectomy to treat conditions such as endometriosis. An obstetrician-gynaecologist, Dr C, noted that when the treatment of endometriosis requires a hysterectomy, which carries the risk of inducing EM, it changes ‘the way [women] look at everything’, including needing to quickly decide if they will have children (see Fertility and early menopause). Chemotherapy is sometimes needed to treat non-cancer conditions such as severe Wegener’s granulomatosis, scleroderma or systemic lupus erythematosus . Some health practitioners commented that the surgical removal of the ovaries or uterus could also impact women’s mental health.

Professor Kulkarni, a psychiatrist specialised in women’s mental health, commented that women with surgical EM sometimes are not advised that hormone therapy can assist with their psychological symptoms.

Cancer treatment and EM

Telling women that their cancer treatment may cause EM can be complex. For some cancers, awareness that treatment can cause EM is increasing. As Dr S, a medical oncologist, observed: ‘Breast cancer is probably the cancer about which a lot is written, so many women are aware that this will induce menopause’.

Health practitioners explained that when women are diagnosed with cancer, their medical team will often focus firstly on treating the cancer to avoid overwhelming women, with conversations on EM occurring later (see Delivery of diagnosis and emotional impact).

Ms Lewis, a breast care nurse, described how conversations about endocrine therapy and EM can occur. 

Health practitioners treating women diagnosed with cancer emphasised the importance of taking a multidisciplinary approach to treatment from initial consultations, as this can support women in their experience of EM.

Dr Richardson, a medical oncologist, shared his experience of working in a multidisciplinary team and how this benefits women experiencing EM symptoms.

Health practitioners commented that women diagnosed with cancer need information on their treatment options and possible side-effects, including EM. Some also considered it important to discuss with women and their partners the potential impact of cancer treatment on personal life and sexuality (see Symptoms of early menopause and Fertility and early menopause).

Ms Hay, a breast care nurse, explained how she speaks to women and their partner about cancer treatment options and their side effects. 

When there is a risk that the cancer treatment will cause a woman’s ovarian function to permanently cease, a few health practitioners noted that they discuss fertility preservation options, along with explaining how the cancer treatment will cause EM (see Fertility and early menopause).

Dr K, a fertility specialist, explained the different options for fertility preservation when diagnosed with cancer.

After cancer treatment and depending on factors such as age and the type of treatment received, some women may recover their ovarian function (see Fertility and early menopause). Dr S noted that while conversations on EM sometimes occur ‘after having a couple of cycles of chemotherapy [when] they have not had periods’, it is essential that women understand ‘that an absence of menstruation does not mean they are infertile’.

For Dr D, an endocrinologist, it is important to carefully explain the impact of endocrine therapy on women’s ovarian function and fertility and how this can vary with age.

Women who have an identified BRCA 1 or 2 gene mutation may elect to undergo a bilateral salpingo-oophorectomy to reduce their risk of ovarian and breast cancer. In those cases, health practitioners remarked, women can be better prepared for EM.

Dr P, a breast surgeon, spoke of the differences between women who experience EM as a result of cancer treatment and those who undergo prophylactic surgery.

Further information:

Talking points (Health Practitioners)

Talking Points (Women)

Other resources