Menstrual Changes and Infertility
Effect of Chemotherapy on the Ovaries
Chemotherapy often affects the follicles in the ovaries that produce eggs. It may suppress egg production temporarily, leading to a temporary cessation of menstrual periods, menstrual irregularity, or it may stop it permanently. When this happens, the menopause commences, and it is not possible to fall pregnant.
The chances of chemotherapy-induced menopause increase with age. At age 30 fewer than one in three women will experience an early menopause from AC chemotherapy, while at age 45 the chances are over 90%.
In all women, even if menstruation resumes normally after chemotherapy it is likely that the menopause will be experienced at an earlier age than would otherwise have been the case.
Cessation of periods during chemotherapy cannot be relied upon for contraception and the use of barrier methods is strongly advised.
Preserving fertility during chemotherapy
Currently the only way to preserve fertility is to have fertilized eggs frozen and stored prior to the commencement of chemotherapy. This is arranged by a fertility clinic. We often to refer to one at Westmead. Briefly, injections are given to stimulate the production of multiple eggs. The eggs are harvested about 10 days later by passing a tube through the vagina. Donor sperm is obtained from the patients partner and used to fertilise the harvested eggs which are then stored permanently in liquid nitrogen. These fertilized eggs can then be implanted in the womb at some future date, when chemotherapy is completed. This IVF technology is not always successful, but many women have had successful pregnancies by this method after chemotherapy. There is no evidence that the IVF process is associated with a higher risk of breast cancer, or that it may exacerbate breast cancer recurrence. Usually it involves a slight delay in the commencement of adjuvant chemotherapy, but this is seldom of medical significance.
Recent evidence from the POEMS study announced at the American Society of Clinical Oncology scientific meeting in 2014, showed that in premenopausal patients with early stage, hormone receptor negative breast cancer receiving chemotherapy, the drug goserelin ("Zoladex") may help to preserve fertility. In the study, the luteinizing hormone releasing hormone (LHRH) analog was given every four weeks starting the week prior to chemotherapy and continuing for the duration of chemotherapy. This was associated with a lower rate of premature ovarian failure and more pregnancies. Common side effects included those similar to that experienced during menopause such as hot flushes, mood swings, vaginal dryness and headache. Whilst this is great news, Zoladex is not currently listed on the PBS for this indication. The injections cost ~$330 per month, however it is worth discussing this option with me at your first appointment
Managing menopause.
Symptoms of early menopause may become confused with the side effects of chemotherapy. These include mood disturbance, weight gain and hot flushes. These are dealt with in the section on Menopause and its Management
Chemotherapy often affects the follicles in the ovaries that produce eggs. It may suppress egg production temporarily, leading to a temporary cessation of menstrual periods, menstrual irregularity, or it may stop it permanently. When this happens, the menopause commences, and it is not possible to fall pregnant.
The chances of chemotherapy-induced menopause increase with age. At age 30 fewer than one in three women will experience an early menopause from AC chemotherapy, while at age 45 the chances are over 90%.
In all women, even if menstruation resumes normally after chemotherapy it is likely that the menopause will be experienced at an earlier age than would otherwise have been the case.
Cessation of periods during chemotherapy cannot be relied upon for contraception and the use of barrier methods is strongly advised.
Preserving fertility during chemotherapy
Currently the only way to preserve fertility is to have fertilized eggs frozen and stored prior to the commencement of chemotherapy. This is arranged by a fertility clinic. We often to refer to one at Westmead. Briefly, injections are given to stimulate the production of multiple eggs. The eggs are harvested about 10 days later by passing a tube through the vagina. Donor sperm is obtained from the patients partner and used to fertilise the harvested eggs which are then stored permanently in liquid nitrogen. These fertilized eggs can then be implanted in the womb at some future date, when chemotherapy is completed. This IVF technology is not always successful, but many women have had successful pregnancies by this method after chemotherapy. There is no evidence that the IVF process is associated with a higher risk of breast cancer, or that it may exacerbate breast cancer recurrence. Usually it involves a slight delay in the commencement of adjuvant chemotherapy, but this is seldom of medical significance.
Recent evidence from the POEMS study announced at the American Society of Clinical Oncology scientific meeting in 2014, showed that in premenopausal patients with early stage, hormone receptor negative breast cancer receiving chemotherapy, the drug goserelin ("Zoladex") may help to preserve fertility. In the study, the luteinizing hormone releasing hormone (LHRH) analog was given every four weeks starting the week prior to chemotherapy and continuing for the duration of chemotherapy. This was associated with a lower rate of premature ovarian failure and more pregnancies. Common side effects included those similar to that experienced during menopause such as hot flushes, mood swings, vaginal dryness and headache. Whilst this is great news, Zoladex is not currently listed on the PBS for this indication. The injections cost ~$330 per month, however it is worth discussing this option with me at your first appointment
Managing menopause.
Symptoms of early menopause may become confused with the side effects of chemotherapy. These include mood disturbance, weight gain and hot flushes. These are dealt with in the section on Menopause and its Management