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Menopause - Overview | May 5, 2022, 7:02 CDT

Chemical Menopause: What Is It?
The effects of this gynecological therapy come on quickly but are reversible.
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In women with certain gynecological conditions, menopause is artificially induced as a form of therapy. Chemical menopause can be a jarring experience for women but usually a temporary one, as well.

The main goal of chemical menopause is to stop the ovaries from producing sex hormones for a short stretch of time. Artificially induced menopause helps avoid surgical removal of the ovary when preserving fertility, said Nishath Ali, M.D., a board-certified OB-GYN at the Baylor College of Medicine in Houston.

Putting the ovaries on pause

To restrain ovarian production of sex hormones, such as estrogen, doctors prescribe a class of drugs known as gonadotropin-releasing hormone (GnRH) agonists. These drugs mimic the body's natural hormones and act on the pituitary gland and hypothalamus in the brain. Hormones produced in the brain prompt the ovaries to produce sex hormones.

Drugs including leuprolide, nafarelin and goserelin, which are all approved by the Food and Drug Administration, put the brakes on these ovary-stimulating hormones. Commonly prescribed for six months to a year, these drugs may take the form of tablets, injections or injectable implants, and nasal sprays.

Doctors may choose to chemically throttle the ovaries for various gynecological conditions. One reason is when women experience endometriosis, wherein tissue similar to the inner lining of the womb grows outside the uterus. Chemical menopause may be prescribed to suppress ovarian activity, slowing down the growth of this tissue outside the uterus and reducing pain.

Similarly, artificial menopause can temporarily shrink fibroids and regulate heavy menstrual flow caused by noncancerous uterine growths. Slowing down sex hormone production with such drugs can also control the progress of early puberty. While chemical menopause may not cure the more severe form of premenstrual syndrome (PMS), known as premenstrual dysphoric disorder (PMDD), it can help with managing hormonal fluctuations.

What to expect when you undergo chemical menopause

Natural menopause takes years to fully manifest and is rife with hormonal fluctuations. As hormone production falls, women may experience certain symptoms on some days but not on others. Before the ovaries stall for good, hormonal levels rarely taper off in a gradual fashion.

On the other hand, chemical menopause kicks in over a period of one to two months. As with natural menopause, women's bodies respond to hormonal changes in a spectrum of ways, but symptoms often begin the same way.

"As often these women are younger, the cessation of periods is rather abrupt and symptoms can be quite debilitating," said Mary Jane Minkin, M.D., a board-certified OB-GYN at Yale Medicine in New Haven, Connecticut.

At first, women may experience hot flashes, night sweats and bad sleep, Minkin said. Women are likely to notice these typical symptoms early. Then comes vaginal dryness, lack of libido, increased urinary frequency and accelerated bone loss, among other signs.

Since some of these effects can be detrimental to overall health and quality of life, doctors may prescribe some additional estrogen and/or progesterone known as add-back hormone replacement therapy. Women may be advised to take a small dose of the hormone, much less than their ovaries make, to tolerate some of the worst symptoms.

For some women, the sudden and exhausting effects of chemical menopause may be followed by a reappearance of their pain once the medication is ceased. In such cases, physicians aim to prolong the use of the drug while ameliorating discomfort with the help of add-back therapy. For instance, supplemental progesterone can help these women endure hot flashes and preserve their bone mineral density, Ali said.

The ovaries 'wake up' after you stop taking these types of medications, so it's temporary, chemical menopause.

Once these drugs have successfully abated endometriosis or another gynecological condition, women are weaned off these medications.

"The ovaries 'wake up' after you stop taking these types of medications, so it's temporary, chemical menopause," Minkin said.

After this therapy, menstrual cycles may be irregular initially but quickly settle back into their normal routine.

Besides this purposeful use of drugs to disrupt ovarian function, chemical menopause can occur as a side effect of chemotherapy for cancer, Minkin said. While some ovarian functions may come back once chemotherapy ends, the ability to regain function can be hard to predict. For younger women being treated for cancer, the ovaries can spring back into action eventually.

Artificially induced menopause may also be done surgically, which involves the removal of both ovaries and the subsequent immediate cessation of monthly cycles. Unlike chemical menopause, the effects of surgical menopause are both swift and permanent.

Ultimately, chemical menopause is one of several ways to treat or regulate endometriosis, fibroids and other gynecological conditions. While often fatiguing, the effects of a drug-induced menopause both appear and recede speedily. By tamping down on ovarian function, physicians attempt to improve the overall well-being of women experiencing painful conditions.

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