Entering menopause as a result of a medical intervention can be intense.

Every year, more than 250,000 women undergo surgery to remove their ovaries (an oophorectomy), and many women also enter medical menopause due to treatments such as chemotherapy, radiation or hormone therapy.

Menopause is a huge transition, even when it’s not medically induced.

Yet with medical menopause, “the sudden and dramatic drop in estrogen often triggers more severe symptoms than the gradual decline that happens with natural menopause,” noted B.J. Rimel, MD, associate director of Gynecologic Oncology Clinical Trials at Cedars-Sinai. “For younger women entering menopause prematurely, symptoms can be especially distressing.”

Medical menopause happens when treatments such as radiation, chemotherapy or surgery temporarily or permanently shut down the ovaries, which then cuts off production of estrogen and other hormones.  

Medical menopause has the same symptoms as natural menopause, including:

• Hot flashes and night sweats
• Vaginal dryness and sexual dysfunction
• Mood changes and low libido
• Bone loss
• Changes in thinking and memory

Unlike natural menopause, medical menopause happens fast—overnight after bilateral oophorectomy and over the course of a few weeks following initiating treatments that damage the ovaries.

Read: Menopause Matters

It’s important for women to discuss with their medical providers the risks and benefits of treatments that lead to medical menopause, including:  

• Oophorectomy. Women who have ovarian cancer, and those who have a high genetic risk, may have both ovaries removed as part of their treatment plan. Women who have had hormone-positive breast cancer may also choose to undergo oophorectomy.
• Radiation to the pelvic area. Radiation to the pelvic area can cause temporary or permanent menopause, depending on the extent of ovarian damage and the patient’s age.
• Chemotherapy. Since chemotherapy targets rapidly dividing cells, it can damage the ovaries, which contain many such cells. Whether the ovaries recover function depends on the type of chemotherapy and the patient’s age.
• Hormone therapy. Treatment for estrogen-positive cancers often includes medications designed to shut down the ovaries and suppress estrogen production. In many cases, the ovaries recover function after treatment ends.

A woman is considered menopausal after she has gone a full year without a period. On average, women experience natural menopause at age 51. However, many women experience perimenopausal symptoms—hot flashes, insomnia, sexual dysfunction and mood changes—five to 10 years before menopause officially begins.

Menopause that happens between ages 40 and 45 is considered “early menopause,” while menopause that happens before age 40 is called “premature menopause.”

“Estrogen plays a role in nearly every system in the body, so early or premature menopause can increase the risk of health issues such as Alzheimer’s disease, heart disease, bone loss, premature aging, even mood disturbances,” said Brooke Kinney, an oncology nurse practitioner at Cedars-Sinai.

Read: Making Sense of Menopause

Before you undergo a procedure or treatment that may lead to menopause, talk to your primary care provider about how to prepare for the transition, particularly if you’re under 45.

“For younger patients who don’t have a history of hormone-positive cancer, starting hormone replacement therapy at the time of medical menopause can help reduce long-term risks, including heart disease, bone loss and dementia,” said Flora Sinha, MD, an internal medicine specialist at Cedars-Sinai who has specialized training in managing menopause.

Think you’re not eligible for hormone replacement therapy? You may be surprised.

“More people are candidates for hormone replacement therapy than we previously realized,” said Rimel. “We now know we can safely offer patients vaginal estrogen, for example, without increasing health risks.”

For people who can’t take hormone replacement therapy, the following strategies may help blunt the effects of medically induced menopause:

• Non-hormonal medications. Certain antidepressants, anticonvulsants and antihypertensive medications can reduce symptoms such as hot flashes and mood changes.
• Supplements. Whether you’ve gone through natural or medical menopause, you may need to supplement your diet with calcium and vitamin D to minimize bone loss.
• Lubricants. Over-the-counter lubricants can make a huge difference for women experiencing vaginal dryness and discomfort during sex. “There are plenty of options—both water-based and silicone-based—that can relieve dryness,” said Rimel.
• Therapy. Medically induced menopause can be jarring. “Working with a mental health professional can help you process the changes and develop coping strategies,” Sinha suggests. Sex therapy and physical therapy to strengthen the pelvic floor muscles can also be beneficial.
• Lifestyle changes. Eating a Mediterranean diet, strength training, cardiovascular exercise and good sleep hygiene can dramatically reduce menopausal symptoms.

“No matter how you enter menopause, it’s important to work with a provider who attacks symptoms from multiple angles,” said Sinha.

You may not be able to control when menopause begins, but you can control your diet. You can make exercise and sleep a priority. And you can partner with your healthcare team to address your unique risk factors.

Read: A Health Guide for Women in Their 50s and 60s