Breast Cancer & Menstruration
Breast cancer treatment can have a significant impact on menstruation, particularly for women of reproductive age. The effects vary depending on the type of treatment, the patient’s age, and baseline ovarian reserve. Here’s how breast cancer treatments influence menstruation and reproductive hormones:
How Breast Cancer Treatments Affect Menstruation
Mechanism:
- Chemotherapy damages ovarian follicles, potentially leading to temporary or permanent cessation of menstruation.
- The likelihood of menstrual disruption increases with:
- Age: Women over 35 are more likely to experience permanent amenorrhea (absence of menstruation).
Effects on Menstruation:
- Temporary amenorrhea during chemotherapy is common.
- Menstrual cycles may resume after treatment, particularly in younger women.
- In some cases, it leads to premature ovarian insufficiency (POI) or early menopause, causing permanent cessation of periods.
- Hormonal therapies for hormone receptor-positive breast cancer (e.g., tamoxifen, aromatase inhibitors) interfere with estrogen production or action.
Effects on Menstruation:
- Tamoxifen: Can cause irregular menstruation or amenorrhea. Some premenopausal women may still menstruate while on tamoxifen.
- Aromatase Inhibitors (AIs): Only used in postmenopausal women or premenopausal women in combination with ovarian suppression. AIs induce menopause-like effects by drastically reducing estrogen levels.
Mechanism:
Mechanism:
- Medications like GnRH agonists (e.g., leuprolide, goserelin) suppress ovarian function by inhibiting hormone production.
Effects on Menstruation:
- Causes reversible amenorrhea.
- Menstrual cycles often resume after stopping the medication.
Mechanism:
- Prophylactic salpingo oophorectomy is done in women with Heriditary breast cancer which will induce surgical menopause
Effects on Menstruation:
- Patient would experience permanent amenorrhea (menopause) and hence patient would need to take care of herself like any menopausal lady.
Potential Long-Term Effects
1. Premature Menopause:
- Common in women receiving chemotherapy or ovarian suppression therapy.
- Associated symptoms: Hot flashes, night sweats, vaginal dryness, mood changes, and osteoporosis.
2. Irregular Cycles Post-Treatment:
- Women who regain ovarian function may experience irregular cycles initially.
3. Impact on Fertility:
- Even if menstruation resumes, ovarian reserve may be significantly diminished, affecting fertility.
Resumption of Menstruation Post-Treatment
- Chemotherapy-Induced Amenorrhea: Menstrual cycles may return within 6–12 months after chemotherapy, especially in women under 35.
- Ovarian Suppression: Cycles typically resume within 3–6 months after stopping GnRH agonists.
- Hormonal Therapy: Cycles may remain irregular or absent for the duration of treatment.
- Regular monitoring of ovarian function (e.g., measuring FSH, LH, and estradiol levels) is essential for women who wish to conceive post-treatment.
Emotional and Psychological Impact
- Menstrual changes and the potential loss of fertility can cause significant emotional distress.
- Psychological support and counselling are beneficial for managing these changes.
