Invited submission to Reproduction and Fertility for “Evolving Perspectives in Management of Menopause Transition” Series

Abstract Menopause following cancer treatment is an increasingly recognised component of survivorship yet remains under-addressed in clinical care. The aim of this review is to synthesise current evidence on menopause induced by cancer treatment, by bringing together current evidence on the underlying mechanisms, clinical manifestations, and management in the context of survivorship care. Evidence was evaluated from contemporary clinical studies, guideline recommendations, and emerging evidence across oncology and menopause research. Cancer treatment-induced menopause commonly results from surgical removal of the ovaries, follicular depletion from chemotherapy, radiation-induced ovarian damage, and in some is chemically induced by gonadotrophin-releasing hormone agonists. The resulting symptom burden is often substantial, including vasomotor symptoms, mood disturbance, genitourinary syndrome, sexual dysfunction, fatigue, and cognitive difficulties that impair quality of life. In addition, premature or early menopause are associated with increased long-term health risks, including reduced bone density, cardiovascular disease, as well as adverse psychosocial outcomes such as infertility and altered self-identity. Menopause symptoms can also overlap with treatment side effects, and management is often complex, requiring an individualised, multidisciplinary approach. While hormone replacement therapy is effective, its use is limited by concerns regarding cancer recurrence in hormone sensitive disease. As a result, non-hormonal and supportive strategies play a pivotal role in symptom management. Despite increasing recognition of the impact of menopause, there are few effective licensed therapies and limited access to specialist support and counselling. Integrated menopause care that incorporates menopause management into oncology pathways offers a pragmatic approach providing holistic, patient-centred strategies, that balance long-term health risks with quality-of-life priorities. Lay Summary Cancer treatment, including surgery, chemotherapy, radiotherapy, or long-term therapies can cause menopause, which is often sudden, resulting in severe symptoms that may overlap with treatment related side effects. Menopause can therefore be complex to manage and there may also be added concerns around promoting cancer recurrence. Menopause symptoms can include hot flushes, poor sleep, mood disturbance, vaginal dryness, reduced sexual wellbeing, fatigue, and problems with memory – these can all impact on daily life. There may also be longer term health impacts, including bone loss and cardiovascular disease. This review brings together current evidence to discuss why treatment-related menopause occurs and how it can be best managed. It highlights that, despite growing awareness, many cancer survivors do not receive adequate information, support, or treatment for these symptoms. As cancer survival improves, menopause care must become a central part of improved survivorship. Personalised approaches to menopause management have the potential to improve long-term health, wellbeing, and quality of life after cancer.