Early Menopause From Breast Cancer Treatment
As a young woman affected by breast cancer, you may have been premenopausal
(having regular periods) or perimenopausal (having periods every now and then) before your diagnosis.
Breast cancer treatments — including surgery to remove ovaries, chemotherapy and hormonal therapy — may cause your menstrual periods to stop a while or permanently.
- You are in menopause if your menstrual cycle 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 chemotherapy, 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.
- If you had regular periods before chemotherapy
- You are in early menopause if your periods end due to treatment that began when you were still premenopausal.
- Doctors sometimes call this premature menopause if it occurs at age 40 or younger.
- Doctors sometimes call this premature menopause
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 receptor-positive and hormone receptor-negative disease may affect your menstrual cycle by lowering the amount of estrogen in your body, affecting 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 (oophorectomy) to reduce estrogen 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)
- Adriamycin, Cytoxan
Hormonal therapy interferes with estrogen production or activity.
- Hormonal medicines called GnRH or LHRH 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 (have gone through menopause).This treatment is mostly used in clinical trials.
- These medicines include leuprolide (Lupron), goserelin
- Tamoxifen does not produce menopause, but it can create menopausal symptoms.
Will My Periods Return?
Your periods may start again at some point after chemotherapy or hormonal therapy. 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 menopause 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.
- 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 tamoxifen or GnRh agonists because these medicines may damage the fetus.
- Birth control pills and other methods that contain hormones are generally not advised during or after breast cancer treatment.
- It is important to avoid becoming pregnant while on tamoxifen
Handling Early Menopause 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.
- 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.
- 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 (lubricant products) or Good Clean Love. Do not use lubricants advertised as warming or arousing. They can be irritating.
- Treatment depletes estrogen
- 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.
- If sex has been painful because of vaginal dryness, you may have less sexual 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.
- Early menopause causes bone density
Even if you have your periods during treatment, you may experience menopausal symptoms from the medicines you take.
Resources on Early Menopause
Online sources for vaginal moisturizers, lubricants and more:
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.
