Following treatment for breast cancer, the loss of fertility is a possibility. Whether or not a woman begins menstruating again after treatments will depend on her age and the types and doses of chemotherapy and/or other adjuvant treatments she receives.

It is common for a premenopausal woman to enter menopause – either temporarily or permanently – from chemotherapy treatments. Menopause includes a wide variety of changes that a woman undergoes as she stops menstruating. Common menopausal symptoms, which may be brought on by chemotherapy, include:

• Hot flashes, including night sweats and sleep disturbance
  
  
• Emotional changes such as depression or mood shifts
  
  
• Vaginal changes such as dryness that can result in uncomfortable or painful sexual intercourse
  
  
• Sexuality changes, including a decrease in desire
  
  
• Weight gain

A woman who is treated for breast cancer often faces the possibility of several long-term side effects from treatment. However, each person and prognosis is different,depending on number of factors. Women diagnosed with breast cancer who wish to have children after treatment should speak to a fertility specialist in addition to her oncologist before making treatment decisions.

Some chemotherapy drugs have a more adverse affect on fertility than others. Most women who have not yet undergone menopause will have irregular menstrual cycles or may experience a total disappearance of periods (amenorrhea). Women who do begin menstruating again after treatment are at a higher risk of entering menopause early than women who did not undergo treatment for breast cancer.

Menopause that is brought on by chemotherapy can start immediately with treatments or be delayed. It may be permanent or temporary (as short as a few months or as long as a few years). Many premenopausal women retain or recover functioning of the ovaries and menstruation once their treatment is complete. However, complete recovery of ovarian function may depend on the woman’s age and the type of chemotherapy drugs that were used in her treatment. Certain chemotherapy treatments may be able to reduce the risk of permanent menopause.

Some research has suggested that certain drugs such as goserelin and leuprolide may help protect a woman's ovaries during chemotherapy treatments. These drugs may help prevent the chemotherapy drugs from attacking healthy cells in the ovaries while destroying cancer cells. More research is needed to determine if these drugs truly protect the ovaries and if they improve the chances of developing regular periods after chemotherapy. Women with certain forms of breast cancer also may be treated with hormonal therapy, such as tamoxifen. Hormonal therapies prevent cancer from receiving necessary hormones that help it to grow. Tamoxifen, like chemotherapy, can affect the ovaries, causing irregular menstrual periods or no periods at all. However, with tamoxifen, women usually return to regular menstrual cycles.

Taking tamoxifen for the standard five-year period, however, does reduce a woman's time frame for having children. Patients taking the drug are advised not to become pregnant due to its risk for birth defects. For many women, waiting five years to become pregnant may not be a realistic possibility.

Women with breast cancer who are facing infertility may be able to preserve their fertility by storing embryos. This procedure is performed by collecting eggs from a woman during several menstrual cycles. The eggs are then fertilized by sperm and stored at a low temperature. After the woman has finished her cancer treatments, the embryos can be thawed and implanted in the uterus.

A more experimental method of preserving fertility involves collecting a woman's eggs and storing them unfertilized. After treatment, the eggs are fertilized and implanted in the women's uterus. This technique has proved to be less successfully in resulting in pregnancy and is usually recommended for women enrolled in a clinical trial on the procedure.

Radiation therapy as a form of treatment also may affect fertility. It is important for women to speak with their cancer care team and obstetrician-gynecologist if a family is being considered. For women who still wish to have children following treatment for breast cancer, there is a risk of damage to the ovaries from radiation. Precautionary measures should be taken if possible to protect the ovaries as well as the other breast.

Surgery, such as mastectomy, rarely has any bearing on whether or not a woman can later become pregnant. Women who are considering reconstructive surgery of the breast using part of the abdominal muscle(s) may want to consult with their physician. It may be contraindicated for someone who wishes to later become pregnant.

For women still in their childbearing years, it is extremely important to discuss birth control with the oncologist because both chemotherapy and radiation can lead to severe birth defects if a woman becomes pregnant during treatment. Safe and effective birth control can include the use of barrier contraceptives such as diaphragms or condoms.

Certain types of breast cancer are closely associated with hormones for growth and development. For that reason, birth control pills are normally not recommended for breast cancer patients. Also, since there is an established link between estrogen levels and the growth of breast cancer, hormone replacement therapy (HRT) may not be recommended for breast cancer survivors. For women who were already taking HRT prior to their diagnosis, stopping this therapy can lead to menopausal symptoms. It is important for breast cancer patients to discuss all hormone related issues with her cancer care team physicians.