ONCOMENOPAUSE

What is Onco-Menopause?

Onco-menopause refers to menopause that occurs as a result of cancer treatment or cancer-related surgery. It can affect people who have had cancer treatments such as:

• Chemotherapy

• Hormone (endocrine) therapy (e.g., tamoxifen, aromatase inhibitors)

• Radiation therapy involving the pelvis

• Surgical removal of the ovaries (e.g., risk-reducing bilateral salpingo-oophorectomy.

 

Unlike natural menopause, which usually happens gradually, onco-menopause often occurs suddenly and symptoms can be more severe.

 

Why Does It Happen?

Many cancer treatments reduce or stop the ovaries' production of estrogen and other hormones. These hormones help regulate body temperature, sleep, mood, sexual health, bone strength, and overall wellbeing. When hormone levels drop quickly, menopausal symptoms can develop.

 

Common Symptoms of Onco-Menopause

• Vasomotor Symptoms

  • Hot flushes (hot flashes)

  • Night sweats

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• Sleep and Energy Problems

  • Difficulty falling or staying asleep

  • Fatigue (persistent tiredness)

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• Mood and Cognitive Changes

  • Anxiety

  • Low mood or depression

  • Irritability

  • Difficulty concentrating or "brain fog"

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• Genitourinary Symptoms

  • Vaginal dryness

  • Vaginal irritation or discomfort

  • Pain during sex

  • Urinary urgency or recurrent urinary tract infections

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• Sexual Health Concerns

  • Reduced libido (sex drive)

  • Difficulties with intimacy or sexual function

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• Long-Term Health Effects

  • Bone loss (osteoporosis)Increased risk of fractures

  • Possible effects on heart health

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Treatment: Vasomotor Symptoms 

Vasomotor symptoms (VMS), including hot flushes and night sweats, are among the most common and bothersome symptoms experienced by cancer survivors. They result from a sudden decline in estrogen levels caused by cancer treatments such as chemotherapy, endocrine therapy, pelvic radiation, or surgical removal of the ovaries. Compared with natural menopause, onco-menopause often occurs abruptly, leading to more severe symptoms that can negatively affect sleep, mood, daily functioning, and overall quality of life.

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Management of vasomotor symptoms should be individualized and often involves a combination of lifestyle measures, medications, and supportive care.

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Lifestyle and Behavioral Strategies

Simple lifestyle modifications may help reduce symptom severity and improve coping:

• Keep the environment cool and use fans when needed.

• Wear lightweight clothing and dress in layers.

• Avoid potential triggers such as:

  • Spicy foods

  • Hot drinks

  • Alcohol

  • Smoking

• Maintain a healthy weight.

• Engage in regular physical activity.

• Practice relaxation techniques, mindfulness, or yoga.

• Consider Cognitive Behavioral Therapy (CBT), which has been shown to reduce the impact of hot flushes and improve sleep and wellbeing.

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Non-Hormonal Pharmacological Treatments

For many cancer survivors, particularly those with hormone-sensitive cancers, non-hormonal medications are considered first-line treatment options.

Commonly used medications include:

• SSRIs

  • Escitalopram

  • Citalopram

• SNRIs

  • Venlafaxine

  • Desvenlafaxine

• Other agents

  • Gabapentin

  • Pregabalin

  • Oxybutynin

  • Clonidine (less commonly used)

Important: Patients taking tamoxifen should generally avoid paroxetine and fluoxetine, as these medications may reduce tamoxifen's effectiveness.

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Hormone Therapy

Menopausal hormone therapy (MHT) is the most effective treatment for vasomotor symptoms. However, its use in cancer survivors requires careful consideration.

• May be considered for selected patients after specialist assessment.

• Generally avoided in patients with a history of hormone receptor-positive breast cancer.

• Decisions should involve shared decision-making between the patient, oncology team, and menopause specialist.

 

Complementary Therapies

Some patients may find additional benefit from:

• Acupuncture

• Hypnosis

• Mindfulness-based interventions

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However, evidence for these therapies varies, and herbal supplements should be used with caution because their safety and effectiveness in cancer survivors are often uncertain.

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