Chemical menopause: what is it and what can I expect?

Some medications, including hormone blockers, can induce a temporary, but often more intense, menopause

Certain medications, such as those used to treat endometriosis and some types of cancer, can stop hormone production in your body
Symptoms of a chemical menopause can be similar to those in menopause but usually start more suddenly and can be more severe
Add-back HRT and testosterone can often be taken, which reduces menopausal symptoms and improves long-term health

What is a chemical menopause?

You may be familiar with the term surgical menopause – where an operation such as a hysterectomy or bilateral oophorectomy (removal of ovaries) induces menopause. A chemical menopause is another type of induced menopause caused by certain medications, including hormone blockers (it can also be known as a medical menopause).

These medications “switch off” your hormones, meaning that the production of hormones oestrogen, progesterone and testosterone is stopped or reduced. This is usually temporary while you are given the medication and is usually reversible after you stop having the medication.

RELATED: Surgical Menopause

Who experiences chemical menopause?

Chemical menopause can be induced by Gonadotropin-releasing hormone (GnRH) analogues. These are synthetic hormones that suppress the production of the hormones oestradiol, progesterone and testosterone. They’re usually given as injections or a nasal spray and brand names include Decapeptyl, Zoladex and Prostap.

GnRH analogues are sometimes prescribed to women with endometriosis, adenomyosis and fibroids. Oestrogen can worsen endometriosis in some women – GnRH analogues can suppress or reduce symptoms of endometriosis or adenomyosis, including pain.

GnRH analogues can also be prescribed to shrink fibroids, and can be used to treat PMDD if no other treatment has been effective, and also be part of some fertility treatment regimes.

Some women with oestrogen receptor positive breast cancer are given GnRH analogues as part of their treatment.

Other medications can also cause a chemical menopause, including some types of chemotherapy and some drugs for psychiatric disorders, such as quetiapine.

Women who undergo a chemical menopause are usually younger than those who experience a natural menopause. They may not be as aware of menopause and its implications, or have concerns around ageing and losing their sense of self. The impact of dealing with a health condition and its treatment, and then experiencing menopause, can be overwhelming so it’s important to know that advice and support is available.

Postmenopausal women who experienced a natural menopause may still experience a chemical menopause due to medications. This is because your body will have been producing hormones (from your brain and other organs and tissues) after your menopause, but chemical medication blocks any hormone production, which can lead to symptoms.

What are the symptoms of chemical menopause?

The most common side effects of GnRH are due to the lowering of hormone levels (oestradiol, progesterone and testosterone) so resulting symptoms are similar to those experienced during menopause. This can include, but is not limited to, hot flushes and night sweats, joint and muscle aches and pains, low or changed mood such as anxiety, loss of libido, memory loss, genitourinary symptoms such as vaginal dryness and urinary tract infections.

Other side effects of GnRH therapies can include headaches, blood pressure changes, weight change and decreased bone density.

When women are without their natural hormones for a longer time, and at any earlier age, they have a higher risk of long-term health conditions, including osteoporosis and coronary heart disease.

How can I treat my chemical menopause?

HRT (oestrogen, progesterone, testosterone) is the first-line treatment for menopausal symptoms for the majority of women. If you are prescribed GnRH analogues, hormone treatments are often prescribed at the same time to reduce side effects and menopausal symptoms. This is known as add-back hormone replacement therapy.

Add-back HRT is replacing the hormones that your body would have been producing naturally if they had not been suppressed by the GnRH analogues. If you are on GnRH analogues to treat endometriosis, it might seem strange to take oestrogen as part of add-back HRT but it’s a lower dose than what your body would create if ovulating – the dose is usually enough to alleviate symptoms but not stimulate endometriosis tissue growth. For some women, progesterone and testosterone are prescribed without oestrogen. It is important that add-back HRT is individualised to the right dose and type of hormones.

RELATED: endometriosis and HRT

Taking add-back HRT is also important to help protect your health – one side effect of GnRH analogues is loss of bone mineral content. Add-back therapy has been shown to reduce this loss [1] so is important in helping to prevent osteoporosis. Add-back HRT can also offer heart and brain protection.

Your healthcare professional will work with you to help determine other treatment and lifestyle options that can help alleviate symptoms. This might include reviewing your diet and exercise levels, offering vaginal hormones, advising on sleep and relaxation techniques, exploring cognitive behavioural therapy (CBT) to help improve emotions, etc. Help is available while you undergo a chemical menopause so be sure to seek it out.

RELATED: managing menopause beyond HRT

References

Wu, D., Hu, M., Hong, L. et al. (2014), ‘Clinical efficacy of add-back therapy in treatment of endometriosis: a meta-analysis’ Arch Gynecol Obstet. 290(3), pp513–523. Doi: 10.1007/s00404-014-3230-8