What the f*ck is artificial menopause?
And what does it mean for a breast cancer survivor who wants to have a baby?
By Lauren Caggiano
For the past 19 months, I’ve physically straddled a few different ages. I’m 39, but with the ovarian reserve of a 37.5-year-old woman. (Yay, science!) I’m also in artificial menopause, so, like women 10 or more years older. I understand what it’s like to experience typical menopause symptoms — hot flashes, night sweats, mood swings, hormonal weight gain, and generally feeling like a stranger in my body.
Yes, it’s as unpleasant as it sounds.
Why would I put myself through artificial menopause?
I’m a recent breast cancer survivor, a metaphorical badge of courage I both unwillingly and gratefully carry. My life and identity forever changed on December 3, 2021, when a biopsy revealed that I had invasive ductal carcinoma, a common (and highly treatable) form of breast cancer.
As if this weren’t bad enough, a cursory search on the internet revealed that not having had a pregnancy and/or not breastfeeding increased the risk of this type of breast cancer. Double whammy for this woman who wanted —and still wants — to have a baby! If there were a prize for winning the sob story of the decade, I felt like I should have won it.
I met with Dr. Han, my breast cancer surgeon/EQ goddess, the following week, and she revealed all the details related to my diagnosis, treatment, and prognosis. The bad news: the mass was really fucking large, like the size of a ping-pong ball. The good news? The monster of a tumor was self-contained in the breast tissue, meaning it likely hadn’t spread into the lymph nodes. (That was clinically confirmed a few months later in the biopsy.) It was stage 2, hormonally positive breast cancer.
Both factors led Dr. Han and her team to conclude they could indeed “cure me.” I periodically review the clinical notes from that day to ground me:
“Disease status is curable. The goal of the treatment is to cure the patient.”
Cancer treatment occupied the better part of my year — the recommended treatment a trifecta of chemotherapy, surgery, and radiation. I tolerated the chemo reasonably well, continued working full-time and enjoyed a social life and other activities. In May 2022, I was declared cancer-free, or in clinical terms, no evidence of disease. After completing radiation in July 2023, I started taking a daily hormone-blocker pill, Anastrozole, to curb the risk of a recurrence.
Of course, in reality, the picture wasn’t that rosy. My medical team presented a laundry list of side effects related to chemo. And — though because of course it is — infertility is one potential outcome, though unlikely for a woman my age. Cue: the too-relatable gyno sketch in Portlandia.
The idea of infertility by age 38 was equal parts terrifying and demoralizing for a person who wants to have a baby. My dark night of the soul — and internet searching — led me to the aptly named Facebook group Babies After Breast Cancer. Joining that community confirmed for me how many women were in the same boat, yet overcame the odds.
Many of the premenopausal women in the group who underwent the same course of treatment at my age or older eventually had babies. The common denominators were Lupron, a synthetic protein that acts as a natural hormone, and acupuncture. Lupron shuts down ovarian activity, effectively keeping the number of eggs unchanged throughout the treatment period.
After reading the success stories, I asked my oncologist what this wonder drug was, and how I could get my hands on it. She was open to exploring the use of Lupron, though she cautioned that its benefits were unclear. I figured it was worth suffering through the side effects for the sake of my peace of mind, and the desire to have a child.
I had my first Lupron injection at my first infusion, and have since received monthly shots. My period stopped shortly after the first dose, as expected. At 37, I was officially thrust into the world of artificial — and temporary — menopause. It’s an experience I describe as getting into an ice-cold pool, headfirst. Under normal circumstances, you have the dubious luxury of time, easing into the hormonal changes and side effects over a period of years.
Artificial menopause meant I went from having the hormonal levels of a menstruating woman in her late 30s to that of a woman in her mid-50s, in just a few weeks.
In addition to the hormonal shifts, I mourned the loss of my menstrual cycle and what it meant for me as a cis woman. There are days when I don’t feel feminine, which is important to me. I sometimes feel defective — less worthy than women my age who still have periods. And no doubt I’ve internalized that, to my detriment.
On two separate occasions, well-meaning friends made innocuous remarks related to menstruation and feminine hygiene products. In those moments, I felt shame, grief, and a sense of loss. Though triggering, I used these encounters as opportunities to share my feelings. After all, how can we survivors in this state expect our friends and family to support us if they don’t understand what we’re going through?
That’s exactly why I wanted to explore this topic through the lens of women’s reproductive health experts.
Experts on what’s happening during artificial menopause
Meet Kristin Mallon, certified nurse midwife and co-founder/CEO of FemGevity, a telemedicine platform.
Kristin acts as an empathetic guide for women making the transition into menopause. Knowledgeable and displaying sensitivity to my trauma, she walked me through the mechanics of artificial menopause and the stigmas surrounding it.
Kristin Mallon: Primary ovarian insufficiency is the loss of ovarian hormonal function before the age of 40, usually related to genetic, autoimmune or metabolic factors. It can also be tied to antigenic factors, which can include chemotherapy and radiation.
They call it primary ovarian insufficiency because there is this theory or this thought or even constant hope that there could be some (future ovarian activity), especially when it comes to chemotherapy and radiation. I do know that there are some women who’ve had ovarian hormone function return (after cancer treatment).
Lauren: How can we change the conversation around this shared experience?
Kristin: Menopause is this really scary, taboo subject because it's associated with aging. And aging is associated with death. Menopause just means you're one step closer to the grave. I think that’s the general consensus of how society sees it now.
(At FemGevity), we're not trying to sugarcoat menopause. We're not trying to change it. We're not trying to rename it — we’re calling it like it is. And it's not scary. We're seeing it as a transition. We're seeing it as this beautiful thing in a woman's life.
Lauren: How can women in my position advocate for themselves in a clinical setting?
Kristin: Self-education is important in seeking out the right practitioner. While oncologists are 100% the first line of defense — they know everything there is to know about cancer and cancer treatment — a menopause specialist lives and breathes menopause, and the hormones associated with menopause. And we do see a lot of women with different types of cancers. We do know a lot about the therapeutics, studies and data. And I think an oncologist doesn't look at the same type of studies on a day-to-day basis as we do. Because we're so desperate to help women and they're desperate to cure cancer. We're desperate to help women's libido and help (them) feel their best.
Dr. Tara Scott is a self-described hormone guru who’s made it her mission to help women of all ages optimize their health. With over 25 years of experience and three board certifications in OB/GYN, Functional medicine, and Integrative medicine, she helps patients and their care teams separate fact from fiction. Here’s what she had to say on our recent Zoom call.
Lauren: Can you explain the nuances of the different types of menopause?
Dr. Scott: The North American Menopause Society defines natural menopause as one year without a period. You're born with so many eggs and you release an egg until you run out of eggs. When you go through menopause — and the average age is 50 — the ovaries can still produce some hormones after your period stops.
Surgical menopause is when you have your ovaries removed. You’re completely getting rid of that source of hormones. Your ovaries are like your monthly paycheck. When you retire, you live off of your adrenal gland, which is your 401(k). DHEA is made in the adrenal gland. The body uses DHEA to make the male and female sex hormones.
When you’re in artificial menopause, you're experiencing a temporary suppression of the ovaries.
Lauren: How can the medical community better support people like myself experiencing artificial menopause?
Dr. Scott: The busy OB-GYN doesn't necessarily have the inclination or the time to learn about this. I just don't think you're going to get that kind of care from your family practice doctor. And so with social media, with the internet, you can seek out somebody who has made it their niche. Through telemedicine, women now have access to — whether it's a naturopathic doctor who specializes in cancer, or somebody like myself. I also think changes will be driven by patients…people like you advocating and writing about it (who will inspire action). I don't think it's going to come from the medical profession, unfortunately.
While I don’t know what the future holds for me and my fertility, I do know that language informs reality. How we talk about these sensitive matters, well — it matters. For now, it’s not goodbye to my menstrual cycle, it’s “see you later.”
Lauren Caggiano is a journalist, copywriter, and editor based in the Midwest. Her burgeoning business, WriteOn, affords her the opportunity to work with local, regional and national publications as well as small businesses and nonprofits, to bring stories to life. When she’s not behind a computer, you can find her in a gym setting. She’s the founder and owner of New Heights Fitness. An ACE-certified Personal Trainer and Health Coach, her expertise and experience lie in strength training and weight management. She works with women across the lifespan to help them live richer, fuller and longer lives by helping them minimize the risk of future health-related issues. On a personal note, she’s a recent breast cancer survivor. She enjoys volunteering, thrift store shopping, eating vegan food and traveling. She’s always open to sharing perspectives over coffee (or Zoom).
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Thank you for this piece - it’s a very important issue. The words “artificial menopause” in the title drew me in - and my comment is just about clinicians giving basic information to women about even what that is, let alone any of the other ramifications such as impact on fertility.
My experience is a while ago and in another country (Australia, so not backward). I was 48 at breast cancer diagnosis, treated with surgery, radiation and then Tamoxifen for 5 years (may be known as Nolvadex in the US). My periods stopped within a few months of commencing Tamoxifen and I was 53 when I finished that regime.
None of the doctors with whom I dealt described the menopause symptoms I’d experienced as ‘artificial’ - not sure if that was because I was on the cusp of the relevant age group anyway.
A few months after finishing Tamoxifen, my period returned - with a bang! Enormous amounts of flow, very distressing. It took another 2.5 years for the periods to eventually finish - and, yay, menopause all over again!
The hot flushes (not a typo; we call them that here) never stopped and still haven’t, so I’ve had them now for nearly 17 years. The other menopause symptoms have abated although of course the legacy remains, such as dryness and thinning of skin. There are of course upsides as well.
My main point is that I didn’t ever imagine I would have to go through menopause twice. Perhaps still a small price (as well as my now yearly mammograms and ultrasound checks) to have come through the cancer as intact as I am. I know many are not as lucky.
I wish the author good fortune with her ambitions.