Early Menopause From Breast Cancer Treatment

Hot in Here: Coping With Symptoms of Early Menopause

Before your diagnosisinfo-icon, you may have been premenopausalinfo-icon, having regular periods, or perimenopausalinfo-icon, having periods every now and then. 

Breast cancer treatments — including surgery to remove ovaries, chemotherapy and hormonal therapy — may cause your menstrual periods to stop for a while or, in some cases, permanently.

  • You are in menopauseinfo-icon if your menstrual cycleinfo-icon stops permanently and you have no periods for 12 months in a row. The average age of natural (not treatment-related) menopause is 51.
    • If you had regular periods before chemotherapyinfo-icon, they may return afterward. The younger you are during treatment, the more likely your periods will return.
    • Talk with your doctor if your period returns after you have missed three or more cycles. 
  • You are in early menopauseinfo-icon if your periods end due to treatment that began when you were still premenopausal.

If your periods stop temporarily or permanently, know that you are not alone. Many young women who are treated for breast cancer experience the same thing.

Understanding early menopause will help you discuss this possibility and your concerns with your healthcare team.

How Treatment Causes Early Menopause

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

Surgery that removes your ovaries to reduce estrogen, called oophorectomyinfo-icon, causes immediate permanent menopauseinfo-icon.

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

  • Chemotherapyinfo-icon destroys egg follicles, which disrupts ovarianinfo-icon 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:

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), goserelininfo-icon (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 postmenopausalinfo-icon, or have gone through menopause already.This treatment is mostly used in clinicalinfo-icon trials.
  • Tamoxifeninfo-icon does not produce menopause, but it can create menopausal symptoms.

Will My Periods Return?

Your periods may start again at some point after chemotherapyinfo-icon or hormonal therapyinfo-icon. Research hasn’t yet shown a good way to predict if you will regain your periods or not, although age is a factor.

The younger you start treatment for breast cancer, the more likely your periods will begin again after chemotherapy or hormonal therapy.  

  • Young women have more egg follicles, so have more left after treatment.
  • Women under 35 have a better chance of seeing their periods return.
  • After age 40, treatment-related menopauseinfo-icon is more likely to be permanent.

If your periods stop during chemotherapy or hormonal therapy, you may still be able to become pregnant. Learn more about how doctors determine whether you may still be fertile.

Before you start treatment with chemotherapy or surgeryinfo-icon to remove the ovaries, it is possible to have eggs removed from your ovaries, frozen, and stored for later use. Talk to a reproductive endocrinologist to learn more about how you can preserve your fertilityinfo-icon

  • Use barrier birth control, such as a diaphragm, condoms, or a non-hormonal intrauterine device (IUD) — even if you’re not having periods.
    • It is important to avoid becoming pregnant while on tamoxifeninfo-icon or GnRh agonists because these medicines may harm a fetus.
    • Birth control pills and other methods that contain hormones are generally not advised during or after breast cancer treatment.

Handling Early Menopause Symptoms

Treatment-related early menopauseinfo-icon can bring on symptoms associated with natural menopauseinfo-icon. 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 flashinfo-icon.
    • Reduce stressful situations. Control your reactions through mindful breathing.
    • Try lifestyle changes first before talking with your doctor about medicineinfo-icon.
    • 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 estrogeninfo-icon, 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 lubricantinfo-icon 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 therapyinfo-icon focusing on pelvic floor dysfunctioninfo-icon. 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 libidoinfo-icon 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 providerinfo-icon or an oncologyinfo-icon social workerinfo-icon about other ways to improve desire.
  • Bone loss
    • Early menopause causes bone densityinfo-icon to weaken. Tamoxifeninfo-icon slows down this process but chemotherapyinfo-icon 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 scaninfo-icon 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.

This article was supported by Cooperative Agreement Number DP11-1111 from The Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention. 

November 7, 2019