The majority of women go through the transition of perimenopause and menopause naturally, yet for a small percentage of women, induced menopause is their introduction to this change of life. Numerous medical reasons and life choices can be behind induced menopause, and we are going to explore them here. What should you know about induced menopause?

What is induced menopause?

Induced menopause refers to menstrual periods that cease after the ovaries have been surgically removed, following radiation or chemotherapy damage to the ovaries, or from use of medications taken to induce menopause as part of treatment for a specific disease or to facilitate gender change. Women who have induced menopause experience the symptoms of menopause, such as hot flashes, mood swings, sleep problems, and breast tenderness, among others.

However, when there is no medical intervention, menopausal symptoms occur over a period of weeks or months rather than years because the transition is sudden rather than something that evolves over time like natural menopause.

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Reasons for induced menopause

Let’s take a closer look at the reasons why a woman may experience induced menopause.

Chemotherapy: Chemotherapy destroys cancer cells, but it also can damage the ovaries. Age is the most critical factor that determines whether chemotherapy will cause treatment-induced menopause. Women who are close to natural menopause age are more likely to experience permanent menopause than their younger peers.

Other factors that have an impact on whether or not chemotherapy will result in treatment-induced menopause are the type of drugs taken, dose of the drug, and how long treatment lasts. For young premenopausal women, the symptoms of induced menopause can be more intense than for older women, but overall the experience varies by individual woman.

Examples of chemotherapy medications that can cause medical menopause are cyclophosphamide, especially when combined with methotrexate and fluorouracil, doxorubicin and fluorouracil, or doxorubicin and docetaxel. Chemotherapy may cause menstrual periods to stop immediately or the effect may take months or a year.

Up to 40 percent of women younger than 40 enter permanent menopause as a result of chemotherapy, and that percentage jumps to up to 90 percent in women older than 40. Among younger women who do get their periods back, they are more likely to enter menopause earlier than cancer-free women.

Radiation: Use of radiation therapy for breast or other types of cancer, especially in the pelvic region, also can damage the ovaries. Induced menopause from this cause may be temporary or permanent, depending on the woman’s age and extent of radiation.

Total hysterectomy/bilateral oophorectomy: Women who have a total hysterectomy (removal of the uterus, fallopian tubes, cervix, and/or both ovaries) or bilateral oophorectomy (removal of both ovaries and sometimes the fallopian tubes) experience induced menopause. Following these procedures, women experience immediate menopause, and the side effects can be intense.

Some of the more common medical reasons for undergoing a complete hysterectomy or an oophorectomy include the presence of difficult endometriosis, ovarian torsion (a twisted ovary), as prevention of ovarian cancer or breast cancer if at high risk (such as changes in the BRCA1 and BRCA2 genes), and treatment for benign or cancerous cysts or tumors.

Induced menopause and gender change

When a woman makes the decision to undergo gender change medically, it typically initially involves undergoing hormone therapy (testosterone). Hormone therapy causes a number of physical and emotional changes, including growth of body hair, increased libido and muscle mass, mood changes, and cessation of menstruation, especially if you are premenopausal. Many trans men opt for surgical procedures, which can include hysterectomy, including ovary removal.

Trans men with induced menopause can expect to experience the traditional menopausal symptoms, including hot flashes, mood swings, and vaginal dryness. In fact, use of testosterone alone promotes vaginal atrophy and the risk of vaginitis and cervix problems.

Chemical menopause

Sometimes a woman and her doctor will opt for chemical menopause, which is induced by use of gonadotropin releasing hormone analogues (GnRHa). These drugs affect the pituitary gland to cause temporary menopause. Also known as chemical menopause, the drugs (e.g., Lupron, Decapeptyl, Orilissa, Zoladex) are sometimes prescribed to treat PMDD.

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You may be familiar with PMS (premenstrual syndrome). Think of PMDD (premenstrual dysphoric disorder) as a severe form of PMS whose symptoms usually improve when menstruation begins. However, the symptoms can include extreme mood changes, severe sadness, and feelings of hopelessness, anger, and irritability, as well as the typical PMS symptoms of bloating, gas, and breast tenderness.

Chemical menopause is used to help diagnose PMDD and help rule out other conditions: the drugs suppress the hormonal fluctuations that occur during menstruation. If no hormonal fluctuations occur, no PMDD symptoms occur.

Bottom line

Induced menopause can occur for a number of different reasons. One thing that is consistent about the resulting experience is that individuals will experience menopausal symptoms following whatever event or procedure behind the induced menopause. Women who are facing the possibility of induced menopause should talk with a trusted medical professional to better understand what symptoms and changes lie ahead.