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How Your Period Changes After Chemo

When many people think of cancer, there are a few images that come to mind: hair loss, exhaustion and the vision of both men and women, needle in their arms, hooked up to a machine administering some of the strongest drugs designed to kill everything in its wake. That’s chemotherapy.

When you’re diagnosed with cancer of any type, there’s a good chance your team of doctors will recommend some type of chemotherapy. Each type is different — the snowflakes of medicine if you will — and their side effects vary. Some people will experience hair loss, nausea, changes in taste, loss of feeling in their extremities — this list goes on and on. But for people who menstruate, there is a side effect many of us don’t even think about, especially when diagnosed at a younger age.

I was 32 and single when I was diagnosed with breast cancer and was faced with obscene amounts of information. There were surgeries to be scheduled and appointments to be made. Somewhere between my mastectomy and the start of my 12 rounds of chemotherapy, I was asked if I’d like to hear options about freezing my eggs.

“Why would I need to do that?” I asked.

“We can assume that you are premenopausal due to your age,” my oncologist explained. “The chemotherapy could push you into early menopause. It’s not guaranteed, but it’s a possibility. If you’re thinking about having children, you might want to think about freezing your eggs. If you are perimenopausal, which is possible, there’s a greater chance the chemo will speed up the menopause process.”

My head spun. I wasn’t even sure if I wanted to keep the plant my ex had given me, let alone have a child at some point, and now there was a chance that I could go into menopause? At 32?

What chemo does to your period

I had never even heard the terms premenopausal and perimenopausal before I had been diagnosed; most young women haven’t. According to Dr. Steve Vasilev, a gynecologic oncologist and medical director of integrative gynecologic oncology at John Wayne Cancer Institute, premenopausal years are the reproductive years before menopause occurs.

“As menopause approaches, increasing symptoms such as hot flashes, irregular periods and vaginal dryness signal perimenopause, meaning your ovaries are starting to fail in terms of producing cyclic estrogen and progesterone,” he tells SheKnows. “This usually starts in the mid to late 40s but can start as early as your 30s.”

Oh, great. So in addition to being injected with poison to kill my cancer, there was also a chance that once I completed treatment, my ovaries would be failing and I would be experiencing the same side effects my mother experienced in her 50s.

I wondered what exactly chemo does to a person’s body that forces our reproductivity to end.

“Chemotherapy can accelerate ovarian failure and cause menopause after one or more treatments, depending on the combination of chemotherapy that is administered, as some are more toxic to the ovaries and the egg-producing follicles than others,” Vasilev explains. “During chemotherapy, normal hormonal cycles are usually altered, which results in irregular periods. In some cases, where the chemotherapy causes complete failure, periods can simply stop and full menopausal symptoms can occur.”

So basically, the stronger the drugs to kill the cancer, the more chance you have to experience early menopause.

Are the changes permanent?

Naturally, my next question was how I’d know if it’s going to be permanent or not. According to Vasilev, whether or not ovarian damage is permanent or not depends on the drugs used, the duration of treatment and how many eggs a person had to begin with.

“The biochemical and metabolic reasons for failure are very diverse, and in most cases, multiple toxicity pathways are in play at the same time,” says Vasilev, “so it is hard to avoid at least a temporary loss of ovarian function.”

It was around my second round of chemotherapy when I noticed something was missing on my calendar: those little marks that each of us make each month to track when our periods are set to begin. The chemo had stalled my period and there was nothing I could do but wait and see if it returned once my treatments ended. I didn’t experience many of the side effects that women going through menopause experience, but to be honest, I was so tired most of the time, even if I had, I probably slept through them.

I completed six rounds of an insanely strong chemo cocktail of three different drugs in April of 2011. Sometime in June, as I was sitting in yet another doctor’s office, I felt a stabbing pain in my lower back and was extremely nauseous. “The cancer. It’s back,” I convinced myself as I locked myself in the bathroom of the office, dry heaving.

But it wasn’t my cancer that was coming back. It was my period. I felt like an old car that had been started up again after sitting in a garage for some time, slow to start, lurching forward but eventually, street legal once again.

I felt a sense of relief (in addition to the intense cramps). I had no idea if my post-cancer future would include children (spoiler: It does not), but it was nice to know that the option was back on the table. Eight years later, the plant is also still doing great.

A version of this story was published October 2018.

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