These therapies may bring on menopause during childbearing years.
One aspect of breast cancer treatment that often gets overlooked is its effect on the reproductive system. Certain types of breast cancer treatment can affect a woman’s fertility, and they can also create menopausal symptoms for women who have not yet reached the typical age of menopause onset (which is usually between ages 45 and 55).
Even if women are not trying to get pregnant, having early menopause symptoms during breast cancer treatment can be a difficult and emotional experience.
“They’re not only dealing with the cancer diagnosis and the side effects of the treatment they’re being given, [but] they’re also dealing with an abrupt menopause, so sometimes hot flashes and other menopausal-type symptoms become an issue,” Amy Tiersten, MD, hematologist and oncologist at Dubin Breast Center, Mount Sinai Hospital in New York City.
In addition to the infamous hot flashes, menopause symptoms can include trouble sleeping, mood swings, and painful sex. These can be difficult to deal with when a patient is already undergoing treatment side effects like nausea, fatigue, and potentially hair loss—not to mention the stress and fear that come with a cancer diagnosis.
There are several treatment options for breast cancer, and two types in particular are known to increase a woman’s chance for menopausal symptoms: chemotherapy and hormone therapy.
Chemotherapy + Menopause Symptoms
Although newer treatment options are more effective and cause fewer side effects than chemotherapy, one subtype of breast cancer—known as triple-negative breast cancer—still relies primarily on chemotherapy. Learn more about treating triple-negative breast cancer here.
The problem with chemotherapy is that it can damage the ovaries while it’s attempting to attack cancer cells. Because the ovaries are responsible for producing estrogen, damaged ovaries result in reduced levels of estrogen. The drop in estrogen causes the body to mimic natural menopause.
Younger women are less likely to experience early menopause from chemo. “Over the age of 40, a course of chemotherapy is more than 50 percent likely to put someone in an early menopause,” says Dr. Tiersten.
Hormone Therapy + Menopause Symptoms
Hormone therapy—specifically anti-estrogen therapy—can also lead to early menopause symptoms. This type of therapy is used to treat hormone receptor-positive breast cancers, a subtype of breast cancer that is fueled by either estrogen or progesterone.
Because anti-estrogen therapy aims to lower the amount of estrogen in the body, it’s perhaps not surprising that it can induce symptoms of menopause.
Dr. Tiersten encourages women to have open dialogue with their doctors about the side effects and symptoms they are experiencing. For example, vaginal dryness can be uncomfortable to bring up, but there are options to help you deal with them. (Learn more here about how breast cancer treatment can affect your sex life here.)
“[Vaginal dryness] is a normal side effect of the drug they’re on, and there are things that can be offered that might help,” says Dr. Tiersten. “Thankfully, there [are] new drugs that have been studied that have been shown to be effective to minimize hot flashes or vaginal dryness.”
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A lot of our treatments for
breast cancer involve menopausal symptoms.
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Many of these women will
go on to need five or
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ten years of an anti-estrogen pill.
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Many of the anti-estrogen medications
have menopausal symptoms as side effects.
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And if that occurs during
childbearing years that is,
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of course, potentially devastating.
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We have various techniques
that patients can use in terms
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of freezing embryos or eggs.
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Because we're frequently in a situation
where we're putting a young
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person into premature menopause and having
to manage the side effects of menopause.
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Thankfully, there's new drugs that have
been studied that have been shown to be
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effective to minimize hot flashes or
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This is not something that
someone might offer on their own,
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and for them to know that it's a normal
side effect of the drug they're on, and
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and there are things that can be offered
that might help, is really important.
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I think it's extremely important for
the patient and
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the medical oncology team to
have a very open dialogue.
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I think being able to have realistic
conversations about prognosis and
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expectations, in terms
of long-term outcome,
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is something that is
very important as well.
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Cancer treatment - early menopause. Washington, DC: MedlinePlus, U.S. National Library of Medicine. (Accessed on May 1, 2019 at https://medlineplus.gov/ency/patientinstructions/000912.htm.)
What is menopause? Bethesda, MD: National Institute on Aging. (Accessed on May 1, 2019 at https://www.nia.nih.gov/health/what-menopause.)