Cancer treatment can cause menopause, even in young women.
Defined as 12 consecutive months without a menstrual period, menopause typically arrives in middle age: the U.S. average is 51 to 52 years old. But cancer treatment, including chemotherapy and other medications, can cause a temporary or permanent pause in periods, while surgical removal of the ovaries or pelvic radiation therapy results in near-instant menopause.
“If you had both your ovaries removed, you’re in menopause,” said Rachel Frankenthal, PA-C, a certified menopause clinician and a physician associate specializing in gynecologic oncology and menopause for cancer survivors.
Chemotherapy is “a toxic agent” that can reduce ovarian function, she said, adding that pelvic radiation can also cause menopause if the ovaries remained in the radiation field.
With natural menopause, ovarian function slowly declines. But surgical-, chemical- or radiation-induced menopause is more abrupt, so symptoms are often more severe.
Besides hot flashes, these symptoms might include joint pain, brain fog and other cognitive issues, mood and mental health challenges, digestive problems, and genitourinary issues such as vaginal dryness and urinary tract infections. Estrogen is an anti-inflammatory hormone, Frankenthal said, so its decline during menopause can also lead to increased inflammation throughout the body and an acceleration of chronic diseases such as cardiovascular disease and osteoporosis.
Frankenthal and Erica Oberman, MD, a co-director of UCLA Health's Comprehensive Menopause Program, OB/GYN and menopause-certified physician, answered questions about coping with these symptoms and more at the 2026 Women’s Cancer Survivors Conference, held in April on the UCLA campus.
Here’s some of what they covered:
Lifestyle and diet are important strategies for menopause symptom management.
Because menopause can increase inflammation – as well as blood pressure, weight and cholesterol numbers – diet and exercise play a vital role in supporting long-term health, Frankenthal said.
“Lifestyle becomes critically important when those hormones walk out the door,” she said.
Eating an anti-inflammatory diet that emphasizes whole foods – fruits, vegetables and lean proteins – and minimizes processed foods can help bring down systemic inflammation. It’s also important to stay hydrated, she said.
Exercise, including weightlifting to build muscle, “is really one of the most powerful things you can do to protect your brain, your bones, your heart, your overall health and longevity,” Frankenthal said. Movement also helps ease joint pain, she said.
Prioritizing sleep and setting boundaries that protect mental well-being are other important strategies, she added.
Some supplements may also be helpful. Omega-3 fatty acids, found in fatty fish such as salmon and as a supplement, support cognitive health. Magnesium can be helpful for muscle tightness, anxiety and sleep.
But beware of multi-ingredient supplements marketed specifically for menopause, Frankenthal advised: “Menopause is a huge market now, and people are making a lot of money on people’s suffering.” Talk to your doctor about any supplements you’re considering.
Topical vaginal estrogen is safe for nearly all gynecologic and breast cancer survivors.
Clinicians often prescribe an estradiol cream to help with genitourinary menopause symptoms, including vaginal dryness, pain during sex, bacterial or yeast infections, recurrent UTIs and “stress incontinence,” or leaking urine when coughing, sneezing or laughing.
These vaginal changes are progressive, Dr. Oberman said, so treatment is recommended.
“We’re going to treat it like we do our faces,” she said. “We put moisturizer on our face every night so we look beautiful in the morning. We do the same thing in our vagina, so it does not get progressively worse”
Studies show topical vaginal estrogen is safe for all breast cancer survivors, even those on aromatase inhibitors, Frankenthal said.
It is also safe for nearly all gynecologic cancer survivors, except for those diagnosed with uterine sarcoma.
“Those are very aggressive uterine cancers and they can be very estrogen-sensitive and often recur in the vagina,” Frankenthal said. “It’s a very rare kind of uterine cancer.”
Recent survivors of advanced or aggressive uterine cancers may opt to wait to begin using vaginal estrogen until two years into recovery, she added, as recurrence risk is highest in the first two years. Non-hormonal vaginal moisturizers can be helpful in those cases, she said.
Many survivors of gynecologic cancers can use systemic hormone therapy.
Women who haven’t been diagnosed with breast or gynecologic cancer may be prescribed hormone therapy – typically a combination of estrogen and progesterone – to help with menopause symptoms. Many survivors of gynecologic cancers and even certain breast cancers may be candidates for this kind of therapy as well, Frankenthal said.
“Gynecologic cancers do not mean that you necessarily can’t use hormones,” she said.
For example, studies show that survivors of the most common kind of ovarian cancer live longer and have longer progression-free survival on estrogen, she said.
Some young women with stage one endometroid ovarian cancer may keep the other ovary, so their bodies continue to make estrogen, Frankenthal added.
Hormone therapy is typically contraindicated in breast cancer, but even then, it’s not absolute, she said. Treatment for triple negative breast cancer does not include removing ovaries, suppressing ovarian function with medications or putting patients on aromatase inhibitors to suppress systemic levels of estradiol, part of the treatment paradigm for estrogen receptor positive breast cancers.
“All cancer survivors deserve an individualized conversation” about hormone therapy that takes into account how long they’ve been in remission, their symptoms, and what non-hormonal and lifestyle options they’ve tried, Frankenthal said. “I really think patient autonomy needs to be a part of that, and then we come together and create a decision that feels right for you.”
More research is needed on the potential benefits of testosterone.
Testosterone is approved for off-label use for women to boost libido during menopause. Some studies have looked at whether testosterone can ease muscle and joint aches and there is data showing it can be helpful, Frankenthal said. But more research is needed.
“When people come into my office asking for it for muscle growth, energy and more – the data is just lacking,” Dr. Oberman said. “I can’t tell you that it’s going to work for you.”
Even using testosterone for low libido isn’t so straightforward, she added: “There’s also body image issues, how I am feeling about my relationship, if I am stressed out today… .” Testosterone begins decreasing in women around age 30, so “usually what is more contributory is aging, because it’s not falling off a cliff like our estrogen and progesterone levels during menopause,” Dr. Oberman said.
When testosterone is prescribed for women, the goal is to restore premenopausal levels, not to approach male levels, she said.
Because menopause is such an individual experience with a wide variety of symptoms, Frankenthal and Dr. Oberman recommended talking with your healthcare team about what solutions are available and what might be best for you.
