The types of treatments young women tend to receive for hormone receptor-positive and hormone receptor-negative disease may affect your menstrual cycle by lowering the amount of estrogen in your body, affect how your ovaries work, or both. These can:

• stop your periods
• lessen or end fertility
• cause menopausal symptoms
• affect bone health

Surgery that removes your ovaries to reduce estrogen, called oophorectomy, causes immediate permanent menopause.

• If you are premenopausal and have estrogen receptor-positive breast cancer, especially if you test positive for a BRCA1 or BRCA2 mutation, your doctor may suggest this type of surgery.
• Many women start having menopausal symptoms as soon as their ovaries are removed. Those effects may be stronger than if you had natural menopause.
• Removing your ovaries is the only surgery treatment that results in early menopause. Lumpectomy or mastectomy alone will not put you into menopause.

Chemotherapy for hormone receptor-positive or hormone receptor-negative disease can stop your periods for several months, or permanently.

• Chemotherapy destroys egg follicles, which disrupts ovarian function. This can make your period stop and cause you to have menopause symptoms.
• Some chemotherapy medicines are more likely to cause early menopause or menopausal symptoms than others, including:
  • Adriamycin, Cytoxan and Taxol (ACT)
  • Cytoxan, Methotrexate and Fluorouracil (CMF)

Hormonal therapy interferes with estrogen production or activity.

• Hormonal medicines called GnRH agonists cause menopause symptoms for as long as you take them.
  • These medicines include leuprolide (Lupron), goserelin (Zoladex) and triptorelin (Trelstar).
  • When on these medicines and temporarily in menopause, you may be given an aromatase inhibitor (AI) at the same time. AIs are hormonal medicines that can only be given to women who are postmenopausal, or have gone through menopause already.This treatment is mostly used in clinical trials.
• Tamoxifen does not produce menopause, but it can create menopausal symptoms.

Treatment-related early menopause can bring on symptoms associated with natural menopause. Here are ways to manage symptoms you may experience:

• Hot flashes
  • Dress in layers you can take off easily to stay cool.
  • Avoid common hot-flash triggers such as hot drinks, smoking, spicy food, caffeine, and alcohol. Find your triggers by noting what you ate or did shortly before a hot flash.
  • Reduce stressful situations. Control your reactions through mindful breathing.
  • Try lifestyle changes first before talking with your doctor about medicine.
  • Low doses of certain antidepressants have been shown to decrease hot flashes and night sweats. Such medicines may be helpful for you if these symptoms are very bothersome.
  • Hot flases usually resolve over time.
• Night sweats
  • These are related to hot flashes, so triggers are similar.
  • Keep your bedroom cool.
  • Avoid heavy comforters or flannel sheets. Sleep with layers of covers that can be removed.
  • Wear lightweight sleepwear, or nothing.
  • The same medicines used to help with hot flashes can usually help with night sweats, too.
  • Night sweats usually resolve over time.
• Vaginal dryness
  • Treatment depletes estrogen, which dries out and thins vaginal walls, vulva, and clitoris.
  • Use non-hormonal vaginal moisturizers such as Replens or Me Again. Oil from vitamin E capsules also works.
  • Before having penetrative sex, use a sexual lubricant such as Astroglide, K-Y or Good Clean Love. Do not use lubricants advertised as warming or arousing. They can be irritating.
• Tight pelvic floor muscles
  • Sometimes, having one painful sexual experience can cause you to unintentionally tighten the pelvic floor muscles when you attempt sex again. Tightening these muscles can make penetration more uncomfortable. If you think this is happening to you, ask about physical therapy focusing on pelvic floor dysfunction. A trained therapist can help you learn how to relax those muscles and improve comfort during sex. 
• Lower sexual desire
  • If sex has been painful because of vaginal dryness, you may have less sexual desire.
    • Use vaginal moisturizers.
    • Spend time enjoying your body and your partner’s (if any) as is comfortable for you until you feel healed from pain.
    • Apply sexual lubricant generously on yourself, any partner or sex toy before penetration or other sexual activity.  
    • Once you have had trouble with sexual activity, you may need to rebuild positive sexual experiences before your libido returns. Patience on the part of both you and your partner can be very helpful.
  • Some antidepressants may reduce sexual desire. Ask your doctor about good options less likely to cause this effect.
  • Talk with your healthcare provider or an oncology social worker about other ways to improve desire.
• Bone loss
  • Early menopause causes bone density to weaken. Tamoxifen slows down this process but chemotherapy and aromatase inhibitors speed it up.
  • Eat calcium-rich foods, such as kale, shellfish and dairy.
  • Walk or run regularly. Weight-bearing exercise strengthens bones.
  • Ask your healthcare provider about whether calcium and vitamin D supplements are appropriate for you and if you should have a bone density DEXA scan test.

Even if you have your periods during treatment, you may experience menopausal symptoms from the medicines you take.

Learn more in our section on menopausal symptoms.