Fertility After Cancer
Many premenopausal women who undergo chemotherapy will experience chemotherapy-induced amenorrhea (the absence of your menstrual period), premature menopause or infertility. Research has indicated that treatment-related menopause is less common in women younger than age 35 and is often related to the type of chemotherapy drugs used, the dosage of the drugs, and the patient’s age. Most premenopausal women will stop menstruating at least temporarily during or following chemotherapy. While they may have symptoms of menopause, we avoid using the term “menopause” as many regain ovarian function even a few years later and could even get pregnant while not menstruating. Instead, many doctors nowadays prefer to use the term “chemotherapy-induced amenorrhea” or CIA.
Because of potential harmful effects in the fetus, you will need to be very careful not to become pregnant while on tamoxifen. Also, a fact not widely known is that tamoxifen was initially developed as a fertility drug. Therefore, even if you are not menstruating regularly, you can still become pregnant while taking this drug and it is important that you and your partner use a non-hormonal form of birth control (such as barrier methods like condoms or a diaphragm). If you suspect you may be pregnant or if you want to become pregnant, make sure you discuss this with your doctors.
Pregnancy and safety
Although the data are limited, there is currently no evidence to suggest that pregnancy after breast cancer increases your chance of recurrence. It is often recommended to wait a few years after the completion of all treatment (this includes tamoxifen) to allow your body to recuperate. In the end, deciding when the best time to have a baby is a very personal decision. Being a cancer survivor should be a factor, but not the deciding factor, regarding when or whether you decide to become pregnant.
The best way to manage your fertility is to speak to your oncologist regarding your family planning desires as soon as possible. There may be ways to reduce your risk of permanent menopause through choice of adjuvant treatments (chemo and/or endocrine therapy). It may also be helpful to speak to a fertility specialist who is familiar with chemotherapy-induced amenorrhea (CIA), premature menopause, or infertility to discuss your options as soon as possible. Ideally, this individual would be someone who works closely with your cancer specialists.
MYTH: I shouldn’t become pregnant if I’ve had breast cancer in the past. Get the facts.