Information & support Information booklets Surgical menopause . Download booklet Order printed booklet . On this page What is the menopause? Surgery for ovarian cancer Chemotherapy treatment Symptoms of the menopause What can I do to help myself? A dry vagina Osteoporosis Can I use HRT? Useful contact information . Ovacome is a national charity providing advice and support to women with ovarian cancer. We give information about symptoms, diagnosis, treatments and research. Ovacome runs a telephone and email support line and works to raise awareness and give a voice to all those affected by ovarian cancer. This booklet is part of a series giving clinical information about ovarian cancer. It is for those who are experiencing the menopause due to surgery and other treatment for ovarian cancer. . What is the menopause? The natural menopause is the time in a woman’s life when her periods stop as her ovaries stop producing hormones. This is usually a gradual process beginning with periods becoming irregular, called the perimenopause, eventually stopping completely. The average age for this is 51 years old. A woman is described as postmenopausal when she has not had a period for one year. Surgery and chemotherapy for younger women who have not gone through the menopause can mean that their menopause starts much sooner than it would naturally. . Surgery for ovarian cancer When a woman has both ovaries removed (bilateral oophorectomy) before she has experienced her natural menopause she will go into the menopause straight away. The removal of a single ovary, leaving one functioning ovary in the body, may lead to a woman experiencing the menopause earlier. . Chemotherapy treatment When just one ovary is removed by surgery, subsequent chemotherapy may cause a drug induced menopause. This can be temporary, or permanent depending on your age, how your ovaries functioned previously and the dosage of chemotherapy. A drug-induced menopause may occur very suddenly, or take several months depending on your circumstances. Chemotherapy can cause menopausal type symptoms, but this is not common. The exception is gemcitabine which is not often used. If a woman is already approaching her menopause (perimenopausal) then chemotherapy can commonly make pre-existing menopausal symptoms worse. Young women given BEP combination chemotherapy (Bleomycin, Etoposide and Platinum) for germ cell ovarian cancer where one ovary is retained, may notice changes to their periods, and may experience a temporary menopause. . Symptoms of the menopause Women have very varied experiences of the menopause. Here are some symptoms that may occur in the short term: Hot flushes Anxiety Mood changes Palpitations Night sweats Feeling irritated Poor concentration Insomnia Poor memory Loss of self-esteem Long term effects can include: A dry vagina Thinner and drier skin Lower or no sex drive Bladder problems Joint aches and pains Heart disease Osteoporosis It can be difficult to deal with the news you have cancer, its treatment and the side effects, as well as experiencing treatment-induced menopause. Early treatment-induced menopause in younger women also means that you have a longer time without the natural benefits of the hormone oestrogen. . What can I do to help myself? Each woman is different, so what you do will depend on your symptoms, how bad they are and how long they last. Some of these suggestions are based on other women’s experiences, rather than research. Hot flushes are the most common symptom. They can happen at any age as oestrogen levels are reduced. They vary in how severe they are and how long they last. It may help you to: Keep a diary of your hot flushes to see if there is a pattern to them. Wear natural fabrics rather than synthetic ones, such as cotton nightwear and bed linen. Find ways to cool down quickly. Keep a bottle of iced water near, use a spray and carry a small fan or pack of wipes. Take cool showers and keep rooms well ventilated. Cut down or stop smoking. The first puff of a cigarette can trigger hot flushes. Exercise regularly, to improve your circulation. This may reduce the intensity of the flushes. Cut down on foods and drinks that trigger flushes. These could include spicy foods, salty and sugary food, chocolate, alcohol, tea, coffee and soft drinks with caffeine. Limit the number of hot drinks you have at night to reduce night sweats. Use relaxation techniques like deep breathing, visualisation and music. Research has shown that cognitive behavioural therapy can help with menopause symptoms. Try complementary therapies such as aromatherapy, homeopathy, massage, acupuncture and yoga. It is important to speak only to qualified therapists and to tell the doctor treating your cancer. . A dry vagina Water-based moisturisers and lubricants are recommended, such as Sylk and Yes. These can be bought online or from health food shops. Moisturisers have a longer lasting beneficial effect for vaginal dryness compared to lubricants. Lubricants are preferred for discomfort during sex. Oil-based preparations are thought to be longer lasting than those that are water-based. Yes is a water-based lubricant and vaginal moisturiser available on prescription but their oil-based lubricant needs to be bought on the high street. Avoid lubricants with ingredients such as glycerin, glycols and parabens as these can cause vaginal irritation. . Osteoporosis Osteoporosis is the thinning of bones making them more prone to fractures. Oestrogen helps bones to stay strong but during menopause oestrogen levels are lowered and you may find that your bones become weaker. This may increase the risk of breaking a bone in later life. If you go through the menopause before you are 45 and have had both ovaries removed, you are particularly at risk. It would be unusual for a woman who has gone through an early menopause to be immediately at high risk from fractures, even if her bones become weaker. Most broken bones happen to women who are over 65 and are caused by falling. Healthy eating and exercise can help you to keep your bones strong. You can ask your GP to arrange a dual-energy X-ray absorptiometry (DEXA) scan to measure your bone density. . Diet and osteoporosis We absorb calcium just as well from food as from calcium supplements so eating well-balanced meals that are rich in calcium will give you all the vitamins and minerals you need for strong, healthy bones. This might include dairy foods, green leafy vegetables, fish such as sardines and pilchards where you eat the bones, nuts, soya beans and tofu. Try to reduce the amount of caffeine, salt, animal protein and fizzy drinks containing phosphoric acid you have, as these can upset the balance of calcium in your body. . Exercising for strong bones Regular exercise helps to retain bone strength. Brief sessions of high impact exercise such as jogging, or simply walking, can be very effective. The current Government recommendation is to exercise for two and a half hours spread over a week. . Can I use HRT? The decision to start hormone replacement therapy after treatment for ovarian cancer can be difficult. Many research studies refer to the use of HRT after the natural menopause, rather than after treatment-induced menopause. Research has shown that using oestrogen-only or combined HRT increases a woman’s risk of ovarian cancer for those who have not had ovarian cancer before. A 2015 study found for every 1000 women taking HRT for five years there will be one extra case of ovarian cancer. You can read more about this on the NHS website. Stopping HRT reduces this risk over time. Few studies deal with the effect of HRT on ovarian cancer recurrence but no overall increased risk of recurrence has been reported. There are conflicting views amongst healthcare professionals about whether women who have had ovarian cancer should have HRT so you will need to discuss this, weighing up the risks and benefits, with your oncologist. . Alternatives to HRT Your doctor may prescribe other medicines to help you manage the symptoms of menopause. Progestogens such as norethisterone and megestrol are synthetic forms of progesterone given as tablets which can help with hot flushes. They may cause side-effects such as a weight gain, bloated stomach, breast tenderness and mood swings. Venlafaxine, citalopram and paroxetine are antidepressants which can help with hot flushes and night sweats in low doses. Gabapentin is an anti-epilepsy drug and clonidine is a blood pressure medicine, both of these may help with hot flushes. Some women use herbal supplements such as black cohosh, agnus castus or dong quai to manage menopausal symptoms. If you are considering using herbal remedies it is important to receive advice from a qualified practitioner. The National Institute of Medical Herbalists lists practitioners. You will also need to let your oncologist know about any herbal treatment you are planning to take, as it can interact with other medications. . Useful contact information: A younger women’s guide to ovarian cancer A joint publication by Ovacome and three other ovarian cancer charities. Royal Osteoporosis Society Manor Farm Skinners Hill Camerton Bath BA2 0PJ Helpline: 0808 800 0035 Website: www.theros.org.uk The Menopause Exchange PO Box 205 Bushey Hertfordshire WD23 1ZS Telephone: 020 8420 7245 Email: [email protected] Website: www.menopause-exchange.co.uk If you would like more information on the sources and references for this fact sheet, please call us on 0800 008 7054. If you would like to discuss anything about ovarian cancer, please phone our supportline on 0800 008 7054 Monday to Friday between 10am and 5pm. . If you would like more information on the sources and references for this booklet, please call us on 0800 008 7054. If you would like to discuss anything about ovarian cancer, please phone our support line on 0800 008 7054 Monday to Friday between 10am and 5pm. You can also visit our website at www.ovacome.org.uk This booklet uses information from The Menopause Exchange and the National Osteoporosis Society. Reviewed by Mr Simon Leeson, Consulant gynaecologist, Department of Obstetrics and Gynaecology, Ysbyty Gwynedd, Penrnosgarnedd, Bangor, Gwynedd, LL57 2PW . Disclaimer Ovacome booklets provide information and support. We make every effort to ensure the accuracy and reliability of the information at the time of printing. The information we give is not a substitute for professional medical care. If you suspect you have cancer you should consult your doctor as quickly as possible. Ovacome cannot accept liability for any inaccuracy in linked sources. v.3.2 Date last updated May 2020 Date for review May 2022 . Did you find this fact sheet helpful? We welcome your feedback. If you have any comments or suggestions, please email [email protected] or call 0207 299 6653.