Unexpected Journeys: Recognizing the Hidden Faces of Menopause This October
- jcardozalmft
- Oct 8
- 9 min read
Updated: Oct 14
By Julie Cardoza, MS, LMFT
Breast cancer treatment can trigger sudden menopause. Preventive surgeries end hormone production overnight. These October awareness months are more connected than we realize—and both pathways deserve visibility, support, and trauma-informed care.
October is Menopause Awareness Month—a time to shine light on a transition that affects millions, yet remains shrouded in silence and misconception. While many conversations center on the "natural" menopause journey, there's a population whose experience often goes unrecognized: those who enter menopause through surgery, medical treatment, or unexpectedly early.
These are the unexpected journeys—and they deserve our attention, understanding, and support.
I know this path intimately. My own journey through surgical menopause taught me what the textbooks don't say: that when menopause arrives suddenly, it brings not just physical symptoms, but layers of grief, identity shift, and a profound sense of invisibility that few understand.
The Double Invisibility of Unexpected Menopause
Even as mainstream conversations about menopause slowly expand, surgical and medically induced menopause remain largely invisible.
When menopause discourse does emerge—whether in media, workplace policies, or healthcare settings—it overwhelmingly centers on "natural" perimenopause and menopause. The stories shared, the symptoms discussed, the support offered—all implicitly assume a gradual, age-expected transition.
October's Dual Awareness: A Missing Connection
October marks both Breast Cancer Awareness Month and Menopause Awareness Month. Yet we rarely discuss their profound intersection.
The reality: Up to 80% of women over 40 treated for breast cancer experience chemotherapy-induced menopause. For younger women, rates range from 10-50% depending on the treatment regimen. Prophylactic surgeries—removing ovaries to reduce cancer risk in BRCA1/2 carriers—trigger immediate menopause. Radiation to the pelvic area can damage ovarian function, leading to sudden hormonal shifts.
Cancer survival includes what happens after treatment. It includes the sudden menopause that follows chemotherapy. The mental health impact that extends far beyond physical recovery. The grief of fertility loss compounded by the relief of survival. The hot flashes during radiation appointments. The brain fog while trying to return to work. The anxiety that feels different from cancer-related fear but is rarely connected to plummeting hormones.
The pink ribbon tells an important story—but it's only part of the story. Where is the conversation about the neuroendocrine aftermath? The long-term mental health support? The recognition that treating cancer while navigating sudden menopause requires integrated, trauma-informed care?
This creates what I call a double invisibility for those on unexpected pathways:
First, you're navigating a transition that society barely acknowledges or understands in any form. The general silence around menopause means most people lack basic literacy about what happens to the body and brain during this neuroendocrine shift.
Second, even within emerging menopause awareness spaces, your specific experience is rarely named. When menopause conversations do happen, they often exclude or overlook surgical, medical, and early menopause entirely. You're told to "join the conversation," but the conversation isn't actually about you.
This layered invisibility compounds the isolation. You may feel:
Too young to relate to typical menopause content aimed at women in their 50s
Too different when your experience includes cancer, chronic illness, or surgical trauma alongside hormonal changes
Dismissed when providers don't connect your mental health symptoms to sudden hormone loss
Alone because even menopause support spaces don't reflect your reality
Unheard when you try to explain that your menopause didn't arrive gradually—it struck like lightning
The stigma is real and it's compounded. There's the general stigma around menopause—the cultural silence, the workplace discrimination, the medicalization or dismissal of symptoms. Then there's the additional stigma of illness, surgery, infertility, or being "too young" for this transition. Many carry shame about hysterectomy, cancer treatments, or bodies that didn't function as expected.
This October, during both Breast Cancer Awareness Month and Menopause Awareness Month, we need to explicitly name and include these experiences. We need to connect these conversations. We need to recognize that cancer treatment, preventive surgeries, and other medical interventions create menopause journeys that are just as valid—and often more complex—than natural transitions.
Awareness without inclusion is not enough. And awareness of one without the other leaves too many in the shadows.
When Menopause Arrives Like a Storm
Not all menopause unfolds gradually. For some, it arrives suddenly—triggered by surgery, chemotherapy, radiation, or autoimmune treatment. For others, it arrives decades earlier than expected through Premature Ovarian Insufficiency (POI) or early menopause.
When menopause is brought on by these pathways, it rarely feels like gentle ripples. Instead, it can feel like a storm—abrupt, layered, and overwhelming. And you're often weathering this storm while surrounded by people who don't even know what you're going through.
The statistics tell a powerful story:
300,000 women per year in the U.S. undergo bilateral oophorectomy (removal of both ovaries), many before age 50
Up to 80% of women over 40 treated with chemotherapy for breast cancer experience medically induced menopause
1 in 100 women experience Premature Ovarian Insufficiency (POI) before age 40
5% of women worldwide experience early menopause (ages 40-45)
Behind each statistic is a person navigating not just the loss of hormones, but often the compounding weight of illness, surgical trauma, fertility loss, and an identity shift that happens far too fast.
Understanding the Layers
What makes surgical and medically induced menopause different isn't just the timing—it's the intensity and abruptness of the neuroendocrine shift.
When both ovaries are removed or hormone production is suddenly suppressed, the body loses critical chemical messengers overnight. Estrogen, progesterone, and testosterone—hormones that regulate mood, memory, sleep, stress response, cardiovascular health, and bone density—plummet without the gradual tapering of natural menopause.
The ripple effects include:
Immediate and intense vasomotor symptoms (hot flashes, night sweats)
Heightened risk of depression and anxiety, particularly when surgery occurs before natural menopause age
Cognitive symptoms including brain fog and memory challenges
Sleep disruption that compounds emotional and physical symptoms
Long-term health risks including osteoporosis, cardiovascular disease, and cognitive decline if untreated
Grief and identity loss around fertility, femininity, body image, and life stage
For many, this transition also intersects with trauma—whether from the illness itself, past medical experiences, or the reactivation of old wounds in the nervous system.
The Nervous System Connection
Here's what often gets missed in medical conversations: sudden hormone loss doesn't just create physical symptoms. It fundamentally disrupts the nervous system.
The ovaries and brain are deeply connected through the neuroendocrine system. When estrogen and progesterone drop suddenly, the brain areas that regulate stress and memory—the amygdala, hippocampus, and prefrontal cortex—are directly affected.
What may look like depression, anxiety, or mood swings is often the nervous system recalibrating in the face of profound change. For those with trauma histories, this hormonal shift can mimic or intensify old survival patterns, making past trauma feel newly present.
This is not weakness. This is neurobiology.
These responses align with polyvagal theory, which explains how the autonomic nervous system responds to perceived threats. Sudden menopause can trigger:
Sympathetic activation (fight/flight): racing thoughts, anxiety, panic, irritability
Dorsal states (shutdown): fatigue, brain fog, numbness, withdrawal
Trauma reactivation: when abrupt hormonal shifts mimic or intensify old survival patterns
Breaking the Silence, Expanding the Conversation
The tragedy is not that these transitions are difficult—it's that they're so often navigated in isolation, without adequate preparation, emotional support, or follow-up care. And it's that even as menopause enters mainstream awareness, these pathways remain in the margins.
Medical providers may lack training in the mental health implications. Mental health providers may not understand the neuroendocrine foundations. And even well-meaning menopause advocates may not realize they're centering only one type of menopause experience.
The result is fragmented care that treats symptoms in isolation rather than addressing the whole-body transformation—and a continued sense of not belonging, even in spaces meant to support you.
This Menopause Awareness Month, we need to expand the conversation to include:
Explicit naming of surgical, medical, POI, and early menopause in all menopause discourse
Recognition that surgical and medically related menopause is a significant life transition—not merely a medical procedure
Age-inclusive awareness that acknowledges menopause can happen at 25, 35, or 45—not just 50+
Informed consent that includes discussion of mental health risks and long-term implications
Coordinated care between medical and mental health providers
Proactive screening for mood, cognitive, and cardiovascular changes
Access to trauma-informed support that recognizes the complexity of navigating illness, treatment, and sudden hormonal change
Representation in media, research, workplace policies, and support communities that reflects ALL menopause pathways
What You Need to Know Right Now
If you're navigating an unexpected menopause journey, here are five truths to hold onto:
What you're feeling is real and valid. The storm you're weathering—whether anxiety that feels unfamiliar, grief that seems disproportionate, or fatigue that penetrates to your bones—reflects real physiological changes deserving of care and compassion.
You are not alone—even when it feels that way. Though your experience may feel profoundly isolating, especially when mainstream menopause content doesn't reflect your reality, hundreds of thousands of people walk similar paths each year. Your invisibility is not your fault—it's a gap in the broader conversation that needs to change.
This is a neuroendocrine transition, not a personal failing. Your symptoms are your nervous system and body responding to profound change.
Healing does not require returning to who you were before. It means moving forward with awareness, support, and the knowledge that you deserve care that honors both your survival and your humanity.
Support exists—but you may need to advocate for it and seek spaces that see you. This includes asking providers directly about the connection between your symptoms and hormonal changes, seeking mental health support that understands this transition, finding or creating spaces that explicitly acknowledge unexpected menopause pathways, and connecting with others who've walked this specific path.
Moving Forward with Clarity and Support
Surgical and medically related menopause represents one of the most abrupt neuroendocrine transitions a person can experience. Unlike the gradual hormonal decline of natural menopause, these pathways thrust the body into immediate hormonal withdrawal, creating cascading effects that ripple through every system.
But here's what's equally true: recognition opens the door to better care.
When we name these pathways, reduce stigma, and provide language for what's happening, we create space for healing. When we bridge medical and mental health care, we address the whole person. When we offer trauma-informed support, we honor the complexity of the journey.
Storms don't mean you are broken. They mean you are weathering a threshold—one that saturates every part of life before clarity and renewal return.
Your Experience Matters
If you are walking this path, your experience is valid. This October—and beyond—know that you deserve care that matches the significance of what you're experiencing. You deserve providers who understand. You deserve support that honors both the medical and emotional dimensions of this transition. You deserve to move forward with dignity, clarity, and compassion.
I've created a free guide, "Unexpected Journeys: Navigating the Neuroendocrine Shift of Medically Related & Surgical Menopause & Mental Health," which explores these pathways in depth and offers practical tools for nervous system regulation, advocacy questions for your providers, and resources for support.
Connect With Me
For Therapy (California only):juliecardoza.com
For EMDR Consultation (U.S. & Canada):juliecardoza.com
For Midlife Wellness & Coaching:heartscapesllc.com
Instagram: @heartscapes_llc | @jcardzlmftEmail: julie@juliecardoza.com
Support Resources
Crisis Support:
National Suicide Prevention Lifeline: Dial 988 or chat at 988lifeline.org
Crisis Text Line: Text HOME to 741741
Medical:
North American Menopause Society (NAMS): menopause.org
International Menopause Society: imsociety.org
Mental Health:
Psychology Today → Search "menopause" or "midlife"
EMDRIA.org → Find certified EMDR therapists
Peer Support:
Daisy Network (POI support)
The Menopause Charity (education + advocacy)
About the Author
Julie Cardoza, MS, LMFT, RYT is a Licensed Marriage and Family Therapist in California, EMDRIA-Approved Consultant, Registered Yoga Teacher, and Certified Menopause and Perimenopause Coach. She is the founder of Heartscapes, LLC, where she offers holistic midlife wellness coaching, nature-based workshops, and trauma-informed menopause education. Julie specializes in polyvagal theory, expressive arts, and the neurobiology of midlife transitions.
Disclaimer
This blog is for educational and informational purposes only and does not constitute medical advice. The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or qualified health provider with any questions you may have regarding a medical condition.
While Julie Cardoza is a licensed mental health professional, this blog is not a substitute for psychotherapy or medical care. Julie Cardoza provides coaching and education services through Heartscapes, LLC, and therapy services through her licensed private practice in California. These services are distinct and offered under separate legal and ethical guidelines.
Key References:
Mosconi, L. et al. (2021). Menopause impacts human brain structure, connectivity, energy metabolism, and amyloid-beta deposition. Scientific Reports, 11, 10867
Parker, W. H. et al. (2009). Long-term mortality associated with oophorectomy compared with ovarian conservation. Obstetrics & Gynecology, 113(2), 344–355
Rocca, W. A. et al. (2011). Oophorectomy, menopause, estrogen treatment, and cognitive aging. Brain Research, 1379, 188–198
Shuster, L. T. et al. (2010). Premature menopause or early menopause: Long-term health consequences. Maturitas, 65(2), 161–166
Webber, L. et al. (2016). ESHRE Guideline: Management of women with premature ovarian insufficiency. Human Reproduction, 31(5), 926–937
Porges, S. W. (2011). The Polyvagal Theory: Neurophysiological foundations of emotions, attachment, communication, and self-regulation. Norton
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