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Cancer, Premature Menopause, and Infertility

Of the approximately 185,000 women diagnosed with breast cancer in the U.S. each year, about 25% are premenopausal. Some chemotherapy and hormone therapy drugs used to treat breast cancer can cause permanent or temporary infertility or premature menopause. This is a concern for women who are still interested in having children. If this applies to you, you should search out ways to preserve your fertility before beginning cancer treatment. Even if you are not menstruating, premenopausal women should still practice birth control while undergoing such therapies because some chemotherapy drugs are associated with birth defects.

Learning about premature menopause and getting support from your doctor or nurse can help women anticipate and better deal with menopause symptoms.

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Radiation therapy will not cause infertility unless it is directed at both ovaries. Occasionally, depending on the type and extent of the breast cancer, the ovaries may be surgically removed or radiated to reduce the amount of estrogen produced. This will cause permanent infertility.

Chemotherapy-induced menopause occurs in 10% to 50% of women younger than 40, and in 50% to 94% of women over 40. Following chemotherapy, a woman may experience months or even years of irregular ovarian function. Depending on a woman's age and the type of chemotherapy used, normal ovarian function may return.

Options for Preserving Fertility

Women with breast cancer who wish to start or expand a family should consider options to preserve fertility before undergoing cancer treatment. This is not always possible. Patients are often overwhelmed by their diagnosis and are most concerned at first with treating the cancer.

New techniques to preserve fertility include:

Freezing eggs or embryos
Freezing ovarian tissue
In 1999, for the first time, re-implanting previously frozen ovarian tissue restored a woman's ovarian function. This technique is not widely available but has the advantage of no ovarian stimulation.
Egg donation
A woman could receive eggs from a donor, which could then be fertilized and implanted once cancer treatment is completed.
Hormonal suppression of the reproductive organs. This approach involves using hormones to place the reproductive organs in a dormant (inactive) state, shutting down your body's production of eggs. This process seems to protect the cells that develop into eggs (germ cells) from damage by chemotherapy. This approach is still being investigated.