Reproductive/Sexual Function15

Adjuvant chemotherapy improves the survival of women with breast cancer, but is associated with late effects of the reproductive system and in turn sexual function. Menopause can be precipitated among premenopausal women who were treated with certain types of chemotherapy that are directly toxic to the ovaries. Issues related to fertility and lactation are of particular concern to younger breast cancer survivors who may have delayed childbearing and not completed their families.

Premature menopause The risk of amenorrhea (either temporary or permanent) after common adjuvant treatments for breast cancer varies by the agent used, its dose, and the patient’s age (Figure 3-3) (Goodwin et al., 1999b; Burstein and Winer, 2000). Most women over age 40 who receive chemotherapy can expect permanent or prolonged menstrual dysfunction. For example, more than 70 percent of women over age 40, and 40 percent of younger women treated with the chemotherapy regimen CMF, will develop permanent ovarian failure (Mrozek and Shapiro, 2005).16 Younger women are likely to have a transient period of amenorrhea and then resume menses.

Roughly one-third (35 percent) of women newly diagnosed with breast cancer are under age 55. Given that the average age of menopause in North American women is 51 years, many of these women will be subject to immediate menopause, and those who continue to menstruate after chemotherapy are at risk for premature menopause. More than half of all women taking tamoxifen experience hot flashes, sweats, and vaginal discharge; however, in most cases, symptoms are mild and subside over time (Fallowfield et al., 2001; Ganz, 2001a).

Premenopausal women who elect to have their ovaries removed (oophorectomy) as a part of their breast cancer treatment, such as women with BRCA mutations, will also experience premature menopause. Women with ER-positive tumors may have an oophorectomy or have the function of their ovaries temporarily suppressed through treatments with hormones (e.g., luteinizing hormone-releasing hormone analogues such as goserelin).


This section of the report is largely based on several comprehensive reviews of reproductive, gynecological, and sexual consequences of breast cancer and its treatment (Burstein and Winer, 2000; Ganz, 2001b; Chlebowski et al., 2003; Kornblith and Ligibel, 2003; Friedlander and Thewes, 2003).


CMF is a regimen that contains cyclophosphamide, methotrexate, and fluorouracil. The risk of ovarian failure is lower with a regimen of doxorubicin and cyclophosphamide than with CMF. Paclitaxel-containing adjuvant chemotherapy does not appear to increase the risk of ovarian failure (Mrozek and Shapiro, 2005).

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