Managing the Health Effects of Menopause and Primary Ovarian Insufficiency

This information will help you understand and manage the health effects of menopause, whether this occurs naturally or from primary ovarian insufficiency (POI).

Natural Menopause

The ovaries hold a woman’s supply of eggs and produce hormones, including estrogen. These hormones regulate the monthly menstrual cycle. Girls are born with about 1 million eggs, but lose eggs as they age. With fewer eggs, it’s harder to get pregnant. For most women in the United States, at age 51, the egg supply becomes so low that the ovaries stop producing estrogen. At this time, monthly menstrual periods end and menopause begins.

The loss of estrogen and menopause can cause a number of changes in the body, including:

  • Symptoms such as hot flashes, night sweats, sleep disturbance, and mood changes.
  • Vulvar (outside of vagina) and vaginal changes.
  • An increased risk of osteopenia or osteoporosis (loss of bone density, or thinning of the bones), which can increase the risk of fractures.
  • An increased risk of heart disease.
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Menopause and Cancer

Some treatments for cancer cause women to develop menopause at a young age. This is also called “premature (early) menopause,” “premature ovarian failure,” and “primary ovarian insufficiency (POI).”

Causes of POI in women with cancer include:

  • Surgical removal of both ovaries.
  • Loss of eggs in the ovaries from certain chemotherapy medications or if the ovaries are exposed to radiation.

Although many women treated for cancer will not develop menopause at a young age, some women develop POI during or immediately after their cancer treatment, and others develop it years later. It is hard to predict if or when a woman will develop POI from cancer treatment.

If you are younger than 40 years of age, call your doctor or nurse if you develop any symptoms of POI, including:

  • Irregular periods for 3 months or longer.
  • No periods for 3 months or longer.
  • Any symptoms of menopause, as described above.

Menopausal symptoms while taking certain medications

Some women are given medications (such as leuprolide) to suppress their ovaries. These will cause menopausal symptoms as long as you are on the medication. If you have not received any other treatment that could cause early menopause, your ovaries should begin to function normally again after you stop the medication.

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Treatment for Symptoms of Menopause

Hormone therapy for POI

If you have developed POI, your doctor may recommend hormone therapy (HT) to replace the hormones your body is no longer producing in their usual amounts. This can prevent some of the health effects of POI.

HT can help by:

  • Treating the symptoms of menopause.
  • Helping to prevent thinning of your bones.

If you have a uterus, your doctor will prescribe estrogen and progestin. If you have had a hysterectomy (a surgery to remove your uterus), your doctor may prescribe estrogen only. HT can be given in several different ways. Your doctor will recommend what is best for you.

Some women are concerned about taking estrogen because of various health risks. However, many of these risks are reported in women who take estrogen at an older age, after they reach menopause naturally. There is no evidence that these same risks occur in younger women who take hormones to replace those they would have naturally produced at their age.

Not all women can safely take HT. It is generally not recommended for women with:

  • Hormone-sensitive tumors (such as breast cancer)
  • A history of blood clots
  • Heart or vascular disease (having a history of heart attacks, high blood pressure, or stroke)
  • Liver disease
  • Unexplained vaginal bleeding

Talk with your doctor to see if HT is safe for you. If you are not able to take HT, there are other ways to manage the effects of menopause and POI. Some of these are described below.

Hot flashes and night sweats

Hot flashes usually begin as a feeling of warmth in your face, neck, chest, and back, which can spread to your entire body. Hot flashes can range from light warming and redness (flushing) to drenching sweats. Some people have 1 or 2 hot flashes a day; others have as many as 3 an hour. They can come on suddenly during the day and can interrupt your sleep at night. For some, they are a mild irritant. For others, they are much more bothersome.

You  can minimize hot flashes by avoiding smoking, caffeine, alcohol, and spicy food. See Managing Your Hot Flashes without Hormones for information on how to manage hot flashes.

Difficulty sleeping

Sleeping well at night can make you feel better and give you more energy. Some people with menopause or POI can experience problems with their sleep, such as having trouble falling asleep or waking up in the middle of the night. See Improving Your Sleep at Home for information on how to manage these sleep disturbances.

Mood changes

Some people experience changes in their mood after menopause. The cause of this is not well understood. If you are feeling anxious or depressed for a prolonged period of time, ask your doctor or nurse for a referral to Memorial Sloan Kettering’s (MSK) Counseling Center for emotional support or to consider medication that may be helpful in treating these symptoms.

Vulvar and vaginal changes

The vulva and vagina become drier and less elastic after menopause. Women who are not able to take HT can manage these problems by regularly using  vaginal and vulvar moisturizers and using vaginal lubricants during sexual activity. Some women may also be able to use vaginal estrogen. See Vulvovaginal Health for suggestions on how to use these products to manage vulvar and vaginal changes and to improve your sexual experience.

If you want more support and information about these issues, talk with your doctor or nurse about the MSK Female Sexual Medicine & Women’s Health Program. To make an appointment, call 646-888-5076. You can schedule an appointment at either of the following locations:

  • Evelyn H. Lauder Breast Center at 300 East 66th Street, between First and Second Avenues
  • Rockefeller Outpatient Pavilion at 160 East 53rd Street, between Lexington and Third Avenues

Bone health

Osteopenia is a condition in which your bone mineral density is lower than normal. Having osteopenia can lead to osteoporosis, a disease in which your bones become weak and more likely to fracture (break). The loss of estrogen production that occurs from menopause or POI can increase the risk of these conditions.

There are things you can do to decrease the chance that osteopenia will progress to osteoporosis, as well as reduce your risk for fractures, including exercise and eating a diet rich in calcium and vitamin D. See Managing Osteopenia or Osteoporosis for information on how to maintain healthy bones. Your doctor may recommend you take a calcium supplement, a  vitamin D supplement, or both if you don’t get enough from your diet. See Calcium Supplements for information on the types of calcium supplements and on how to take them.

Heart health

The loss of estrogen production that occurs from menopause or POI may affect your heart health. There are a number of ways to reduce your risk of heart disease.

  • Don’t smoke. If you need help quitting, contact the MSK Tobacco Treatment Program at 212-610-0507.
  • Eat a heart-healthy diet and maintain a healthy weight. For tips on how to do this, see Eat Your Way to Better Health.
  • Exercise regularly. Any exercise that raises your heart rate for 30 minutes, 5 days a week, is a good option.
  • If you have high blood pressure, diabetes, or high cholesterol, ask your doctor or nurse about how best to treat these.
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Additional Resources

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