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?

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  • Liz

    Hi Jan,
    My name is Liz and I am very sorry to hear that you had so many negative side-effects of chemo and radiation. I am happy to hear about the new trial medication that may reduce those symptoms, hopefully others will not have to face what you faced. Yet from only your picture on the blog I would not have assumed you are not in your early forties. IT is very fortunate that you did have your sons before hand so at least chemo and cancer did not take that away from you.
    That said,I wanted to reach out to you to see if you were interested in a new online social support network (that I am the community manager of!) called I Had Cancer. It is a new and free social support network focused on connecting people (fighters, survivors and supporters) based on experiences with cancer so that they can easily communicate with one another and share information. I would love to tell you more if you are interested, so please let me know! I would love to send you an early-access pass with extra invites for others you may know going through this journey.

    Either way take care and best regards.

  • jhasak

    Hi Liz, thank you for sharing. I am very glad my sons were born before cancer would have robbed me of them. And cancer is a robber, no question. Yes, I am interested in your I Had Cancer social support network. Please send me an early-access pass when you have a chance. XOXO, Jan


    This post really spoke to me. I, too, have suffered all the side effects of lack of estrogen. Vaginal dryness, thinning hair and old lady skin are the ones that bother me most, but I’m still here, so I’m grateful…. Until Wednesday when I took a friend for her cancer surgery. After the surgeon came out to talk w/me, I went to her hospital room to wait for them to bring her from recovery. As they wheeled her into the room, a nurse, older than I am, said to her, “Your mother’s been waiting for you.” While my friend is 13 years younger than I am, and technically I could be her mother, it was a shock to hear someone say that. I’m out of estrogen and feeling old and withered.


  • jhasak

    Oh, Brenda, I know just how you feel. When I have to tell people my age, no one says, “You don’t look that old.” But I hear those precious words spoken to other women my age. I would so long to hear them spoken to me. What is it about my appearance? I don’t feel old. But that estrogen depletion does a number on so many levels. I know we should be grateful just to be alive and all that, but it is still hard–and hurtful–to be thought older than we really are. You are truly beautiful, Brenda (I’m sure James would agree with me if he could). Don’t let anyone take that away from you.


  • Nancy

    Jan, Cancer is a robber isn’t it? It takes so much. I really feel for all the young women who don’t get a chance to have children because of cancer. Studies like the one you mention offer some hope there.

    Sometimes when I look in the mirror these days, my appearance actually startles me. I look like a different person really.

    I’m sorry you have had to endure so many side effects, Jan. The cancer robber is also unkind.

  • jhasak

    Yes, Nancy, the cancer robber is indeed unkind. He takes but never gives back. That’s why this study resonated with me. It gives back something: hope to younger women undergoing chemo. Thanks for sharing. XOXO, Jan

  • pinkunderbelly

    Once again you’ve written something that really hits me: how much cancer robs from us. Not just the big stuff, like loss of body parts and fear of a shortened life-span, but the little things too like lack of estrogen. Thankfully I’m done having babies, but don’t like the effects of chemically-induced menopause on my 42-year-old body. My OB-GYN said that every symptom is amplified in artificially-induced menopause. None of my friends have gone through “the change” yet and think the hot flashes are quite amusing. I sweat like a weightlifter while doing mundane tasks. I often wonder how much faster I’m aging because of this dreaded disease. I do hope the new drug spares the next round of women from the hell of early menopause.

  • Lizabeth

    It’s funny because when I was diagnosed at 41 in 2005 I was asked to be in a study where they would “turn off” my periods prior to the treatment. I felt that what was coming would be bad enough, so I turned them down. Now at 48, with what I am going through, I wish I had known better. You don’t realize how much menopause affects your body in the long term.

    For me right now the severe aches in my joints which make it hard to exercise, along with the front of body weight gain that seems unstoppable are really getting to me. I am beyond the hot flashes and thought I was scott free, but this is worse. At least that was something that I could dress and undress for, but now, as you said I look in the mirror and don’t recognize myself or feel like myself, and I have so little control. At first recovering from the chemo and radiation I felt like an old woman, but I kept feeling better year after year. Then I started having severe back pain which made me unable to exercise for several years, and I am still struggling with it due to severe pain that lasts for days every time I exercise with any vigor. I was searching and searching to find anyone else who had this chemo-induced muscle “dysfunction”. But now I am wondering if it is actually a result of the menopause and not the chemo.

    I was in the midst of divorce when diagnosed and have not had a serious relationship since then, but would like to, of course. Last night I went out with someone and just felt so heavy and old… am I going to feel like this for the rest of my life? Is it going to even get worse over time?

  • jhasak

    Thanks for sharing your story. I think it will get better over time for you. Jan

  • Lizabeth

    Thanks Jan,

    Today feeling a bit better. I went out and got some Femmenessence which I had used successfully a few years ago for my symptoms, as well as some Kiel’s vitamin C serum, which helps with face appearing younger (also Oil of Olay sculpting cream). I am going to an extra yoga class too, which I have read can help with some of these symptoms. In terms of feeling better, I will let you know how the Femmenessence and yoga go…

  • jhasak

    Yes, Lizabeth, do let me know how that goes. I hope you get to feeling much better.

  • chemovagina

    Especially knowing now, and never having been warned before the treatment, that chemotherapy induced menopause can eradicate a woman’s ability to have sex, and that this can be permanent. It’s a pretty cruel blow at any age, but in your thirties? Horrendous.

  • Molly

    I stumbled upon this conversation while trying to find more information about chemo induced menopause myself. My last chemo treatment was a month and a half ago, so still early to assume anything, however I have been experiencing hot flashes for months and night sweats as well, and have not a had period for at least 4 months. I will be 38 in a month and I have never really understood all that comes with menopause. I have a 17 yr old daughter and don’t plan on having anymore children, so that isn’t an issue for me or my husband. After reading your comments about looking older, achy joints etc, I’m beginning to see that it’s not just about the menstrual cycle. I feel I may have had a few pre-menopausal symptoms before starting chemo as well. I was sick for over a year before being diagnosed with Hodgkin’s Lymphoma, and had 6 months of chemo. I am generally a very holistic person, and chose natural healing and remedies over chemical or anything with long term side effects. Obviously I chose to kick my cancer with chemo, and it’s saddens me to realize how much it has changed my life. I have been so positive, or tried to be, and I didn’t look back once about treatment. I have also had some very positive changes in my life and my way of thinking that I wouldn’t trade for anything. But wow, what a huge load of changes to deal with. Not always so easy to go with the flow. I suppose I could be jumping the gun about the menopause thing, but the more I read, the more likely it seems it is probably whats happening. Thank goodness I have an amazing general doctor that is going to help me get things as balanced as possible.