Did breast cancer treatment cause permanent menopause at 38?

Question

Hello doctor,

I am a 38-year-old woman diagnosed with metastatic breast cancer eight months ago, with spread to my liver and bones. Since starting chemotherapy, I have gone into what appears to be treatment-induced menopause - my periods stopped completely, and I am experiencing severe hot flashes, night sweats, and vaginal dryness that makes intimacy with my husband extremely painful. The emotional toll of potentially never having children is devastating, as we were planning to expand our family when I received my diagnosis.

My oncologist mentioned that pregnancy would be inadvisable with my current condition, but I am struggling to accept this reality. I am also experiencing significant bone pain, especially in my pelvis and spine, which affects my daily activities and my intimate relationship. The hormonal changes have caused mood swings and depression that feel overwhelming on top of dealing with cancer.

I am concerned about my quality of life and how long I might have with my family. My hair loss from chemotherapy, combined with the physical changes from treatment-induced menopause, has severely impacted my self-image and femininity.
I am also worried about genetic testing and whether I should advise my teenage daughter about potential risks.
Is the cessation of my periods due to chemotherapy temporary or permanent, and what does this mean for my long-term health?
Are there safe ways to manage severe menopausal symptoms like hot flashes and vaginal dryness while undergoing cancer treatment?
What are the realistic options for preserving fertility or having children with metastatic breast cancer?
How can I maintain intimacy and sexual health with my partner while dealing with treatment-related vaginal dryness and pain?
Should my teenage daughter undergo genetic testing for BRCA mutations, and when is the appropriate time?
What palliative care options are available to manage bone pain while maintaining quality of life?
How can I address the depression and grief related to potential infertility while managing my cancer diagnosis?

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I have read your query, and I fully understand and appreciate the amount of fear and anxiety you are experiencing after being diagnosed with metastatic breast cancer.

First of all, I want to reassure you that everything has a treatment, and every day, new drugs are being developed. There are now many medications that can address almost all cancer-related problems and help control the disease at all stages. Since you are in stage four, we usually prefer to use immunotherapy or targeted therapy at this stage. This is determined after you undergo the appropriate genetic testing. Based on the genetic test results, we can identify the most suitable targeted therapy for you and also determine whether you are BRCA (breast cancer genes) positive or not. If you are BRCA positive, we recommend that your daughter undergo genetic testing as well once she reaches the age of 25. There is no need to do this before the age of 25, as it would not be beneficial. We wait until she turns 25 and then perform the genetic test.

As for you, targeted therapy and immunotherapy have an excellent effect and significantly reduce the side effects associated with chemotherapy, such as hair loss and the issues you experienced previously with chemotherapy.

These side effects are reversible, meaning your hair will grow back and your strength and overall health will return, often even better than before.

I would also like to mention that you may be eligible to enroll in a clinical trial, which can provide emotional support as well as financial support, especially if immunotherapy is expensive for you.

Regarding bone pain, we can use localized radiotherapy to reduce the pain. It is also very important for you to receive monthly Denosumab injections, which are given subcutaneously once a month. This treatment reduces bone metastases and should be taken along with calcium and vitamin D. All of these measures help reduce pain and discomfort throughout the day.

And as for the investigations, you need to get a genetic test done.

And for the treatment plan, immunotherapy, targeted therapy, palliative radiotherapy, and Denosumab monthly injection.

Have a follow-up every seven days.

I hope my explanation is clear to you, and I do not want you to be afraid. Everything has a treatment, and every day, new therapies give us renewed hope.

If you have any questions at any time, we are always here to help.

Thank you.