Menopause permanent after chemo?

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Question from Website Question: For adjuvant chemotherapy in premenopausal breast cancer women, is the induced menopause reversible? How do we know whether the menopause is going to be permanent? Does this influence the choice of hormonal therapy (i.e., tamoxifen or aromatase inhibitor)?

Answer —Mindy Goldman, M.D.: It's a difficult question to know whether someone's menopause is temporary or permanent. For most women who get chemotherapy when they are less than 40 years old, they tend to get their periods back. There is data, however, that suggests women who get chemotherapy tend to go into an earlier menopause than they normally would. One of the ways that we can tell if someone is getting return of ovarian function is to do a blood test where we check someone's estradiol level.

This is important because if someone is on a drug like tamoxifen, they may not get periods because of tamoxifen itself, yet they still may have had return of ovarian function. It's important to note that 50 percent of women who are on tamoxifen will generally have changes in their menstrual cycles, and the most common is either less frequent cycles (called oligomenorrhea), or no periods (called amenorrhea).

Other hormonal drugs are the aromatase inhibitors, and those are only effective in postmenopausal women. In order for them to be used in premenopausal women, you need to have ovarian suppression, which is usually done by other hormonal drugs, such as Lupron (chemical name: leuprolide). Those drugs can make a woman pseudo-menopausal and then allow the aromatase inhibitors to be used. Depending on your particular cancer, it would be up to your oncologist to decide whether tamoxifen or an aromatase inhibitor would be used.

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