Chemo-Induced Menopause: A premature dip into the future

  • 19 July 2011

At 43 I was starting to experience perimenopause, with its characteristic intermittent bleeding during my period. My periods were getting irregular, but I figured that was normal–and it was for my age.

But then cancer struck.

No one forewarned me about chemo-induced menopause. I had no idea what I was in for. As the nurse poked to find compliant veins for infusing the CMF chemo cocktail, I was thinking only of the immediate: the pain and when were they ever going to find a vessel that didn’t roll away. During later rounds of chemo I stressed about the temporary side-effects like hair thinning, nausea, fatigue, cracked skin and the usual cast of characters.

Two months into the chemo, in May, 1996, I lost my periods forever. While the oncology nurses filled me with hope that perhaps this menopause was reversible once I finished treatment, I wasn’t so optimistic. And sure enough, the menstral cycles never returned.

Now on the one hand, I was happy to free myself from Tampons and Kotex for good. No more carrying them around in a purse or buying them in a restroom. But, on the other hand, I mourned the loss of this era of youthfulness and would now only be further depleted of estrogen.

Later I learned that I was not alone in my premature change-of-life. Approximately 40% of women who take chemotherapy experience early menopause, although the incidence is more likely with certain types of chemo. All I could hope is that my menopause would be similar to my mother’s, which she said was a breeze. No such luck.

The first symptoms showed up as hot flashes and night sweats. My husband thought I was kidding when I told him at night that my feverish-feeling body was going through night sweats. But it was the new-normal, the new reality show.

Other permanent changes plagued me more gradually: thinning hair, drier vaginal area, weaker bones leading to osteopenia. I also realized I wouldn’t be able to have any more children. But unlike some women under 40 in my breast cancer support group, I didn’t desire to have a child after chemo. I already had three sons who gave me great joy. But some  ladies in my group had not yet started having children and didn’t want chemo to rob them of this blessing.

When I reached my late forties and people started asking me if I wanted the senior menu, I faced the ultimate in reality checks. Did I really look that old to people? After all, I colored my hair.  I cursed the chemo demon for robbing me of the rest of my youth.

My plight did not improve. When a recurrence necessitated my taking Arimidex for six years, I knew this bone-depleting and hair-thinning agent would further eliminate any illusions of youth. After all, it acted as an anti-estrogen. How many more insults could my body take?

So I took special interest when I read a new study on an experimental drug that might prevent chemo-linked menopause.

I rejoiced first of all because researchers are looking at the long-term consequences of chemo for women, rather than just assuming (as they did in the not-so-distant past) that they will not live long enough to enjoy quality of life. More and more of us are demanding a decent lifestyle with as few disabilities as possible for however many years we have left.

The study results showed that more than 63% of women on chemotherapy who took the drug triptorelin regained their menstrual cycles, as compared to about 50% of the women on chemotherapy who did not take the drug. Triptorelin is believed to stop the ovaries from functioning for a period of time while the chemo courses through the circulatory system.

The study looked only at premenopausal women ages 18 to 45 with early-stage breast cancer. But I had fit that category in 1996.

The article notes that the ovary-protective drug is far from being the standard of treatment for this category of women. It will have to undergo further testing. Those women with breast cancer who need to have chemotherapy and want children are still best off going through in vitro fertilization before treatment, and then preserving frozen embryos for later implantation.

Still, this drug provides hope to women who don’t want chemo to limit their options in life. If the drug might allow them to get pregnant after chemo, why not go for it?

I surely would have loved the option of taking triptorelin with my chemo when I was 43. I probably would have opted for it even though the long-term effects were unknown. Isn’t that true for all experimental drugs for breast cancer? We live with that risk every day (as with tamoxifen or an aromatase inhibitor), but not every day do we get the promise of a new drug that would increase our long-term quality of life.

If you are a women 45 or under who has had breast cancer, would you have opted for this drug if it were available when you were treated? If so, would you do it for fertility reasons or to avoid the other effects of premature menopause? How do you view unknown long-term side-effects of such drugs?