Chemo-Induced Menopause & Hot Flash Relief

Chemotherapy can shut down the ovaries. When that happens, menopause does not arrive gradually over several years. It can arrive in a matter of weeks. It arrives in the middle of cancer treatment, often at an age when you were not expecting it.

The National Cancer Institute explains that certain chemotherapy drugs stop the ovaries from producing mature eggs and estrogen. NCI singles out alkylating agents, which "present a high risk to your fertility." High doses raise the risk further. So does having several drugs at the same time. Three other things can have the same effect: radiation to the pelvis, surgery to remove the ovaries, and hormone-blocking endocrine therapy.

NCI calls the resulting condition primary ovarian insufficiency. This is not always the same as permanent menopause. NCI says the changes "may be temporary or permanent." Some people go into early menopause. Others with primary ovarian insufficiency "still ovulate and have irregular or occasional menstrual periods." Whether your ovaries recover depends partly on your age. It also depends on which drugs you received. Ask your oncologist directly rather than guessing.

NCI lists the symptoms of primary ovarian insufficiency. They are hot flashes and night sweats, irregular or absent periods, joint pain and muscle aches, mood swings or mood disorders, sleep problems, vaginal dryness, and loss of libido. One point matters. NCI notes these symptoms "can be more intense than in natural menopause."

NCI describes a hot flash as a sudden warm feeling over your face, neck, and chest. It may make you sweat, and it often reddens the face. When it happens during sleep, it is called a night sweat. In people treated for breast cancer, NCI reports that severe hot flashes have been linked with sleeping problems, a lot of pain, and poor mental health. Among premenopausal survivors, they have also been linked with depression. So if your hot flashes are wrecking your sleep, raise it. That is a medical problem, not a nuisance to absorb quietly.

Estrogen. Estrogen replacement controls symptoms well. But NCI says many women are not able to take it, and gives women who have or had breast cancer as its example. Those women may need a drug that has no estrogen in it. NCI also says hormone replacement that combines estrogen with progestin "may increase the risk of breast cancer or breast cancer recurrence."

Non-estrogen prescription options. NCI lists megestrol and medroxyprogesterone. It also lists certain antidepressants, anticonvulsants, and clonidine, a blood pressure drug. For men treated for prostate cancer, progestin and antidepressants are used. NCI is blunt about the trade-off. Studies report these drugs "do not work as well as estrogen replacement or have side effects." Antidepressants can cause nausea, fatigue, dry mouth, and appetite changes. NCI warns that some "may change how other drugs, such as tamoxifen, work." Anticonvulsants can cause fatigue, dizziness, and trouble concentrating. Clonidine can cause dry mouth, fatigue, constipation, and insomnia. If one drug does not help, NCI notes that switching may.

Non-drug approaches. NCI describes cognitive behavioral therapy, relaxation techniques, and hypnosis. They are ways to gain a sense of control and build coping skills. NCI says these may be effective when used together with drug therapy. It also suggests practical comfort measures. Wear loose-fitting cotton clothing. Use fans or open windows to keep air moving.

Supplements — where the evidence is weak. This is where honesty matters. NCI reports that vitamin E was "only slightly better than a placebo." Soy and black cohosh were "no better than a placebo in reducing hot flashes." Ground flaxseed and magnesium oxide produced "mixed results." Then there are dong quai, milk thistle, red clover, licorice root extract, and chaste tree berry. NCI says little is known about how they work, or whether they affect breast cancer risk. It advises talking to your doctor before using them. Tell your team about every supplement you take alongside your medicines.

Acupuncture. A review of studies showed slight or no effect in people with breast cancer who had hot flashes. But some individual trials did show a reduction, including one using electroacupuncture in survivors. The picture is genuinely mixed.

Primary ovarian insufficiency is not only about symptoms. NCI states it causes low bone mineral density and weakening of the bones (osteoporosis). It also raises the risk of heart and cardiovascular problems. Ask who is monitoring your bone density and your heart risk over the long term.

Maybe fertility matters to you and treatment has not started yet. NCI notes that survivors were less regretful if they had met with a fertility specialist. That held regardless of what they finally decided.

• Call 911, or call or text 988 for the 988 Suicide and Crisis Lifeline, if you are having thoughts of suicide. The line is open around the clock, every day, including for people who are deaf or hard of hearing.
• Call your care team the same day if low mood, hopelessness, worthlessness or losing all pleasure in things you used to enjoy has gone on longer than two weeks. Depression has been linked with severe hot flashes in premenopausal survivors, and it is treatable in its own right.
• Call your care team within a day or two if hot flashes and night sweats are wrecking your sleep night after night, or a medicine you were given for them is causing side effects you cannot live with. Switching drugs is a normal next step rather than a failure.

• National Cancer Institute — Depression (PDQ), Patient Version: https://www.cancer.gov/about-cancer/coping/feelings/depression-pdq
• National Cancer Institute — Hot Flashes and Night Sweats (PDQ), Patient Version: https://www.cancer.gov/about-cancer/treatment/side-effects/hot-flashes-pdq
• National Cancer Institute — Female Fertility and Cancer Treatment: https://www.cancer.gov/about-cancer/treatment/side-effects/fertility-women