What is Medical Menopause?

Natural vs Surgical vs Medical Menopause: Temporary or Permanent

Woman having night sweats
What is medical menopause and why can it be temporary or permanent?. Getty Images/Peter Dazeley

If you're living with breast cancer, your oncologist may have talked to you about medical menopause. What does this mean? How does it differ from natural menopause as well as surgical menopause? And is it likely to be temporary or permanent?

Why is Menopause Important With Breast Cancer?

For women who are premenopausal at the time of their breast cancer diagnosis and have estrogen receptor positive tumors, medications (or surgery) to induce menopause may be considered.

We are learning that the use of aromatase inhibitors after tamoxifen treatment may reduce the risk of recurrence, but aromatase inhibitors cannot be used by those who have not yet reached menopause.

If you have had chemotherapy you've very likely stopped having periods, especially if you were nearing menopause to begin with. Even if this is the case, your doctor may recommend testing to see if you are truly menopausal. To better understand this, let's talk about the different types of menopause, the difference between temporary and permanent menopause, and why this is so important.

The Different Types of Menopause

There are actually several different types of combination of types of menopause. Depending on the type, menopause may be temporary or permanent, and this is important in deciding upon the best breast cancer treatments if your tumor is estrogen receptor positive.

Natural Menopause

Natural menopause is a gradual process during which a woman's fertility decreases.

During natural menopause, a woman's ovaries stop maturing eggs, and her body creates less estrogen and progesterone, her menstrual cycles taper off and eventually cease. When the menopause process is complete, a woman is no longer able to become pregnant. Natural menopause is almost always permanent.

Surgical Menopause

Surgical menopause occurs when a woman's ovaries are surgically removed, or she has a total hysterectomy (removal of uterus and ovaries,) and her estrogen levels drop dramatically. Without ovaries or uterus, a woman is not fertile. Surgical menopause is often more symptomatic than natural menopause due to the suddenness of the change. Surgical menopause is permanent.

Medical Menopause

Medical menopause is the result of medical treatments that may damage a woman's ovaries or suppress her estrogen and progesterone levels. Chemotherapy, anti-estrogen hormone therapies, and pelvic radiation treatments can cause a sudden drop in female hormone levels, resulting in temporary or permanent menopause. This type of menopause may be referred to as:

  • Medical menopause
  • Medically-induced menopause
  • Chemotherapy-induced amenorrhea
  • Chemical menopause
  • Chemopause

After chemotherapy, many women experience temporary menopause, but it can be variable whether your periods will return or not. If you were nearing natural menopause this is less likely than if you were younger and far from menopause at the time of diagnosis. When medical menopause is temporary, it is hard to know (without lab studies) whether the menopause is temporary or permanent, and the period of time before you know can vary.

Some women experience temporary menopause for a decade before they become premenopausal again and their period's resume.

This poses difficulty if your oncologist wishes to prescribe a drug that is only used in people who are postmenopausal. Aromatase inhibitors may be more effective than tamoxifen in preventing recurrence, but if you are premenopausal they are not sufficient to reduce your estrogen levels and tamoxifen is needed unless you also receive ovarian suppression therapy

Temporary Medical Menopause/Ovarian Suppression Therapy

If you are nearing menopause, your oncologist may do blood tests to attempt to determine if you are truly in permanent menopause or not.

If you are a young premenopausal woman, temporary medical menopause via ovarian suppression therapy may be prescribed. In order to keep your estrogen and progesterone levels low, but still keep your ovaries healthy, you may be given drugs to "turn off" your ovaries.

(In the past, surgical menopause via removing the ovaries was often recommended. Not only is this an invasive procedure, but eliminates the option for women to pursue pregnancy in the future after treatment.)

Ovarian suppression therapy allows women to take an aromatase inhibitor and reap the benefits of this therapy. These drugs suppress hormones that are released from the pituitary gland and tell the ovaries to produce estrogen. When these drugs are stopped, your menstrual cycle may resume.

Contraception During Medical Menopause

It's important to practice contraception while in treatment for breast cancer, even if you experience medical menopause. There is a small chance that you may conceive during treatment, and we don't fully understand the effects of these drugs on early pregnancy. Do not use birth control pills or any kind of hormonal contraceptives. Options may include a copper IUD, condoms, spermicide, or other barrier methods to prevent conception.

With Medical Menopause Might You Experience Menopause Twice?

If you are in medical menopause, does this mean you might have to experience menopause twice? The answer depends largely on your age and how close to menopause you are. If you are in your late 40s at the time you are diagnosed and go through chemotherapy, your medical menopause may carry you into post-menopause without a recurrence of your menstrual cycle. If you are 30 at the time of diagnosis, however, you may experience natural menopause in the future. If you are at least five years away from natural menopause, your periods may return after treatment and your fertility may rebound. (Learn more about how breast cancer treatments may affect your fertility.) At least when the second time around arrives, you will be more ready with your coping strategies, having survived medical menopause already.

Sources:

Jerzak, K., and K. Pritchard. Ovarian Suppression in Premenopausal Women With Estrogen Receptor–Positive Breast Cancer: Implications of the 2016 ASCO Guideline for Clinical Practice. ASCO Post 06/1-/16.

Lambertini, M., Del Mastro, L., Viglietti, G. et al. Ovarian Function Suppression in Premenopausal Women with Early-Stage Breast Cancer. Current Treatment Options in Oncology. 2017. 18(1):4.

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