When Surgery Triggers Early Menopause: What Every Woman Should Know
While most women experience natural menopause around age 49, thousands in the UK face an abrupt transition due to medical interventions. Surgical removal of ovaries or damaging treatments like chemotherapy can plunge women into menopause years earlier than expected, often with more severe symptoms.
Medical Treatments That Can Cause Early Menopause
Surgical menopause occurs when women undergo oophorectomy - removal of ovaries - to treat conditions like ovarian cancer. Some women with genetic predispositions, such as those carrying the BRCA1 gene like Angelina Jolie, choose this procedure to reduce cancer risk by stopping oestrogen production.
Other pelvic surgeries including removal of ovarian cysts or endometriosis treatment can also damage ovaries and trigger menopause. Medical treatments like chemotherapy, radiotherapy for cancer, and therapies for rheumatological conditions such as lupus can be toxic to ovaries, causing premature ovarian failure.
Whether medical treatment causes menopause depends on age, underlying ovarian reserve, and treatment type and dosage. Younger women typically have greater ovarian stores and can withstand more damage before experiencing menopausal symptoms.
Diagnosis and Timing of Treatment-Induced Menopause
Menopause due to medical intervention often occurs earlier than natural menopause. When it happens between 40-45 years, it's classified as early menopause, affecting approximately 12% of women. Before age 40, it's termed premature ovarian insufficiency, affecting around 4% of women.
Diagnosis differs between surgical and treatment-induced menopause. Surgical menopause is immediately clear, while medical treatment cases require tracking irregular periods for four months plus blood tests showing high follicle-stimulating hormone levels.
Women whose periods stop spontaneously still have some chance of ovarian function returning, but this is less likely after medical treatments and impossible following surgical removal of ovaries.
Symptoms and Health Risks of Early Menopause
Symptoms of oestrogen deficiency like hot flushes typically begin quickly after surgical menopause, while others such as vaginal dryness develop more gradually. Surgical menopause symptoms are often more intense than natural menopause, though experiences vary between individuals.
Low oestrogen from premature ovarian insufficiency can cause multiple health concerns including vaginal dryness, reduced libido, muscle decline, bone loss, and potential brain function impairment. It also increases cardiovascular risks, with higher danger after surgical menopause than spontaneous cases.
Premature ovarian insufficiency can significantly impact mental health, quality of life, and work ability. Women with surgical menopause cannot become pregnant, while those with premature ovarian insufficiency are unlikely to conceive naturally.
Treatment Options and Healthcare Guidance
Research shows women with early menopause and premature ovarian insufficiency often receive substandard healthcare. To address this, updated 2024 evidence-based guidelines include 145 recommendations for treating these conditions.
Hormone-replacement therapy (HRT) remains the primary treatment, replacing missing oestrogen plus progesterone if the uterus remains. HRT provides symptom relief and bone protection, though it's unsuitable for women with hormone-sensitive breast cancers.
Alternative treatments include vaginal oestrogen for dryness and cognitive behavioural therapy for managing hot flushes, sleep issues, and mood changes. While some women find Chinese herbal medicine helpful, insufficient scientific evidence supports most complementary therapies for premature ovarian insufficiency.
Healthcare providers should discuss potential symptoms and risks before starting treatments that might cause surgical menopause or premature ovarian insufficiency. Conversations about preserving fertility and minimising risks should include specialist referrals when appropriate.
