Chemotherapy can set off early menopause, whereas methods and new information on pausing remedy might assist girls defend fertility and plan being pregnant.
Chemotherapy is the therapy more than likely to trigger early menopause, particularly for girls over 40, stated Dr. Elizabeth Sakach, breast medical oncologist at Winship Most cancers Institute of Emory College. Endocrine remedy might not set off menopause itself however typically causes signs like sizzling flashes, sleep issues, weight achieve and sexual dysfunction.
Methods similar to egg preservation or ovarian suppression will help defend fertility, although outcomes differ. Sakach highlighted new information exhibiting some sufferers can safely pause endocrine remedy to conceive with out elevating recurrence threat. She additionally famous treatment-induced menopause raises long-term issues for bone and coronary heart well being, underscoring the necessity for survivorship care.
CURE: How do completely different most cancers remedies, similar to chemotherapy, radiation or hormone remedy affect ovarian operate and probably set off early menopause?
Sakach: Of these therapies, chemotherapy has probably the most important affect on ovarian operate and might trigger early menopause in many ladies, particularly over the age of 40. Radiation doesn’t have an effect. Fortunately, with endocrine remedy we don’t discover it hastens menopause or causes girls to enter early menopause, but it surely definitely causes menopausal signs.
What are the most typical indicators and signs of treatment-induced menopause that sufferers ought to pay attention to?
This may sadly be complicated for a lot of girls, as lots of the identical indicators and signs of menopause may be skilled simply due to present process a breast most cancers prognosis, emotionally processing this large life change and the stress and anxiousness that comes with that.
Nonetheless, temper adjustments are frequent, similar to important anxiousness and melancholy which are out of proportion to what sufferers have skilled up to now. Sizzling flashes, sleep disturbances and cognitive adjustments — similar to issue focusing or word-finding issue — are additionally quite common. Girls will typically report sexual dysfunction, together with vaginal dryness and decreased or absent libido, in addition to weight achieve or hassle shedding pounds.
That is actually important for girls. Greater than 95% of ladies really achieve weight on chemotherapy, which is stunning to many, and it may be very tough to lose or preserve weight as soon as we additionally begin prolonged durations of endocrine remedy.
Are there methods to cut back the chance of untimely menopause throughout most cancers therapy, similar to fertility preservation or ovarian suppression methods?
Sadly, a lot of the chance of untimely menopause from these remedies is predicated on biology and age. The danger is bigger in girls older than 40 on the time they obtain chemotherapy, whereas girls youthful than 30 don’t expertise chemotherapy-induced amenorrhea, or lack of durations, as typically. Ovarian operate typically returns in girls beneath 40 — perhaps 50% of the time — however the majority of ladies over 40 won’t have return of ovarian operate as soon as they’ve had chemotherapy, and that’s a big proportion of our sufferers.
We do use ovarian operate suppression, similar to GnRH agonists like Lupron (leuprolide), given in partnership with chemotherapy in premenopausal sufferers who hope to protect ovarian operate or fertility. However the information behind this strategy is combined, so we warning sufferers that it’s not a surefire strategy and doesn’t assure return of ovarian operate.
How does treatment-induced menopause have an effect on long-term well being, together with bone density, coronary heart well being and cognitive operate?
This can be a tremendous necessary query and really an space of unmet want. Remedy-induced menopause impacts every of these areas considerably, and we’re working to develop sturdy survivorship clinics to deal with these points as a result of many sufferers are surviving their most cancers now, however we should guarantee they do properly for years after therapy.
Bone density is tremendously impacted by estrogen deprivation. Our bones depend on estrogen to remain wholesome. Girls with high-risk illness typically want extra estrogen deprivation to cut back recurrence threat, however this will increase the prospect of osteoporosis. These on most endocrine remedy — aromatase inhibitors plus ovarian operate suppression — are in a menopausal state. We don’t advocate this mixture for greater than 5 years attributable to osteoporosis threat, so after 5 years we swap them to tamoxifen to finish 10 years. We monitor bone density carefully and encourage weight-bearing train, vitamin D and calcium consumption.
For coronary heart well being, we all know girls in early menopause have an elevated threat of heart problems, together with coronary heart assaults and coronary heart failure. That is possible attributable to greater levels of cholesterol, and sadly lots of our therapies additionally contribute. Tamoxifen, nevertheless, can enhance lipid profiles, so it doesn’t carry that very same threat. Nonetheless, this stays an space of unmet want, and we aren’t certain of the easiest way to watch these sufferers. Training and consciousness are an necessary first step.
The cognitive affect is much less clear. We all know girls who bear surgical menopause (eradicating ovaries earlier than pure menopause) face elevated threat of dementia and cognitive impairment, however information on endocrine remedy’s affect is combined.
For youthful sufferers involved about fertility and future pregnancies, what steering are you able to present earlier than, throughout and after most cancers therapy?
If sufferers are about to start remedy, particularly chemotherapy, it’s actually necessary to have open, sincere conversations with their suppliers about household planning. Assembly with a reproductive endocrinologist or fertility specialist early is essential.
The gold commonplace is egg preservation, although it may be pricey and time-consuming. We additionally assist utilizing GnRH agonists with chemotherapy instead — this “calms” the ovaries, in idea defending them from publicity — however whereas proof exhibits it helps, it could not totally protect fertility.
Importantly, we now have the POSITIVE trial to information sufferers. About 500 girls with early-stage, hormone-positive breast most cancers paused endocrine remedy after two to 3 years to attempt to conceive. Round 75% efficiently grew to become pregnant and delivered wholesome infants. They have been capable of keep off remedy for as much as a 12 months to breastfeed earlier than restarting endocrine remedy, and this pause didn’t improve recurrence threat. That is actually unbelievable information to lastly have for these girls and their households.
Reference
- “Breastfeeding After Breast Most cancers Proves Protected in Early Trial Outcomes,” CURE, Aug. 31, 2025; https://www.curetoday.com/view/breastfeeding-after-breast-cancer-proves-safe-in-early-trial-results
Transcript has been edited for readability and conciseness.
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