Early Menopause due to Chemotherapy and Radiotherapy

Key points

  • Premature ovarian insufficiency (POI)/ failure (premature menopause) is loss of ovarian function before age 40 years. Early menopause is menopause before age 45 years.
  • Chemotherapy/ radiotherapy causes POI due to impaired follicular maturation and/or direct primordial follicle loss.
  • The extent of damage depends on the age and pre-treatment ovarian reserve of the woman, type of drug or radiation field and cumulative dose.
  • Amenorrhoea may be permanent or temporary with subsequent development of POI/ early menopause.
  • Currently there is no reliable biochemical predictor of menopause.
  • The most effective and established means of preserving fertility in young women are oocyte and embryo cryopreservation prior to starting treatment. Treatment with GnRH agonists can decrease the risk of POI but impact on fertility is less clear

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Chemotherapy is usually administered as part of cancer treatment but chemotherapy may also be given to women with severe connective tissue disorders such as systemic lupus erythematosus or kidney disease such as Wegener’s granulomatosis. Total body radiotherapy is used in the treatment of lymphoma and bone marrow transplantation and pelvic radiotherapy is used in the treatment of gynaecological cancer. Chemotherapy and radiotherapy used to combat cancers carry a substantial risk for ovarian toxicity, and as survival rates for many cancers in women of reproductive age are increasing, more women are facing infertility and menopause as a consequence of their cancer treatment.

Menopause in women younger than 40 years of age is called premature menopause or premature ovarian insufficiency (POI)/ failure. Menopause occurring between 40-45 years of age is called early menopause1. Diagnosis of premature or early menopause has long term physical and psychological consequences, so women may need emotional support and long-term medical follow-up.

The impact of chemotherapy and radiotherapy on the ovaries

What are the consequences of loss of ovarian function?

Diagnosis of Early Menopause

Management of POI/ Early menopause

Fertility issues:

Hormone (replacement) therapy (HRT)

Prevention of bone loss:

Prevention of cardiovascular disease:

Cognitive function:


Early Menopause: Experiences and Perspectives of Women and Health Practitioners: https://healthtalkaustralia.org/early-menopause-experiences-and-perspectives-of-women-and-health-professionals/

Support Groups:

June 2017; revised September 2020                                                              


1. Webber L, Davies M, Anderson R, et al. ESHRE Guideline: management of women with premature ovarian insufficiency. Hum Reprod 2016; 31(5): 926-37.

2. Spears N, Lopes F, Stefansdottir A, et al. Ovarian damage from chemotherapy and current approaches to its protection. Human Reproduction Update 2019; 25(6): 673-93.

3. Gargus E, Deans R, Anazodo A, Woodruff TK. Management of Primary Ovarian Insufficiency Symptoms in Survivors of Childhood and Adolescent Cancer. Journal of the National Comprehensive Cancer Network 2018; 16(9): 1137-49.

4. Chemaitilly W, Li Z, Krasin MJ, et al. Premature Ovarian Insufficiency in Childhood Cancer Survivors: A Report From the St. Jude Lifetime Cohort. The Journal of Clinical Endocrinology & Metabolism 2017; 102(7): 2242-50.

5. Zhao J, Liu J, Chen K, et al. What lies behind chemotherapy-induced amenorrhea for breast cancer patients: a meta-analysis. Breast Cancer Research and Treatment 2014; 145: 113+.

6. Zavos A, Valachis A. Risk of chemotherapy-induced amenorrhea in patients with breast cancer: a systematic review and meta-analysis. Acta Oncologica 2016; 55(6): 664-70.

7. Chen H, Xiao L, Li J, Cui L, Huang W. Adjuvant gonadotropin-releasing hormone analogues for the prevention of chemotherapy-induced premature ovarian failure in premenopausal women. Cochrane Database of Systematic Reviews 2019; 3: CD008018.

8. Vassilakopoulou M, Boostandoost E, Papaxoinis G, de La Motte Rouge T, Khayat D, Psyrri A. Anticancer treatment and fertility: Effect of therapeutic modalities on reproductive system and functions. Critical Reviews in Oncology-Hematology 2016; 97: 328-34.

9. Gazarra LBC, Bonacordi CL, Yela DA, Benetti-Pinto CL. Bone mass in women with premature ovarian insufficiency: a comparative study between hormone therapy and combined oral contraceptives. Menopause 2020.

10. Burgos N, Cintron D, Latortue-Albino P, et al. Estrogen-based hormone therapy in women with primary ovarian insufficiency: a systematic review. Endocrine 2017; 58(3): 413-25.

11. Tauchmanova L, De Simone G, Musella T, et al. Effects of various antireabsorptive treatments on bone mineral density in hypogonadal young women after allogeneic stem cell transplantation. Bone Marrow Transplantation 2006; 37(1): 81-8.

12. Kiriakova V, Cooray SD, Yeganeh L, Somarajah G, Milat F, Vincent AJ. Management of bone health in women with premature ovarian insufficiency: Systematic appraisal of clinical practice guidelines and algorithm development. Maturitas 2019; 128: 70-80.


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Content updated September 2020