Table of ContentsView AllTable of ContentsSide EffectsAssociated DrugsRisk of Birth DefectsFertility PlanCopingFAQs
Table of ContentsView All
View All
Table of Contents
Side Effects
Associated Drugs
Risk of Birth Defects
Fertility Plan
Coping
FAQs
The exact impact on fertility, which refers to a person’s ability to conceive through intercourse and carry the pregnancy to term, depends on your stage in life, menstrual history, hormone levels, the type of cancer and treatment, and the treatment doses. It can be hard to predict if someone is likely to be fertile after chemo.
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Chemotherapy and Ovarian Function
Chemotherapy can damage the female reproductive system, including thereproductive organsand the hypothalamic-pituitary axis, which is responsible for hormonal regulation.
The hormones that are needed to release eggs each month, such asestrogen, and prepare the uterus for a possible pregnancy are made in the cells of the ovaries called oocytes.
Higher doses of these drugs are more likely to cause permanent fertility changes, and combinations of drugs can have greater side effects. The risk of permanent infertility is even higher when you are treated with both chemo andradiation therapyto the abdomen or pelvis.
What Is Radiation Therapy?Radiation therapy (also called radiotherapy) is a cancer treatment that uses high doses of radiation to kill cancer cells and shrink tumors. At low doses, radiation is used in X-rays to view inside your body, as with X-rays of your teeth or broken bones.
What Is Radiation Therapy?
Radiation therapy (also called radiotherapy) is a cancer treatment that uses high doses of radiation to kill cancer cells and shrink tumors. At low doses, radiation is used in X-rays to view inside your body, as with X-rays of your teeth or broken bones.
Effect on Menstruation
Amenorrheais the absence of aperiod, or menses. There are two types of amenorrhea, which include:
In one study of 1,043 women aged 20–35, all of whom got their initial cancer diagnosis at least two years before, 31.6% developed amenorrhea. Of those diagnosed with amenorrhea, 70% resumed their periods, and 90% did so within two years.
Effect on Fertility
There are factors that contribute to a higher risk for infertility, and others that might not affect fertility at all, such as:
It’s important to remember that even if periods start again after cancer treatment has stopped, fertility is still uncertain. A fertility expert may be needed to help you determine if you are fertile or learn how long the fertility window may last.
Many of the drugs used to treat cancer can harm the developing fetus during pregnancy. People usually are advised to use birth control to avoid getting pregnant during treatment.
Even if you think you can’t get pregnant, you should talk to your healthcare provider about options. It’s important to know what kind of birth control is best and safest for you to use. If you want to get pregnant, talk with your healthcare provider about how long you should wait after treatment ends.
Effect on Menopause
Chemotherapy-induced menopause is also known asmedical menopause. Your periods may stop temporarily during chemotherapy, or they may stop for good. The older you are, the higher the risk that this menopause will be permanent.
The medication Cytoxan (cyclophosphamide) has been associated most closely with medical menopause, especially when used as part of a regimen called CMF: cyclophosphamide, methotrexate, and fluorouracil, or 5-FU.However, other chemotherapy combinations can also lead to medical menopause, such as:
Even if your periods continue during chemo, you may have menopausal symptoms. It’s similar to being in the state calledperimenopause, which can start eight to 10 years before menopause. If you’re closer to natural menopause and were already having symptoms from that, you may find they get worse during chemotherapy.
The younger you are, the more likely it is that this menopause will only be temporary, and your periods will come back. Studies have found that up to 40% of women under 40 go into permanent menopause as a result of chemotherapy, while 70%–90% of women over 40 do.
In the case of CMF in particular, about half of premenopausal women stop their periods while on it. Among those in their 30s, about 25%–50% can expect to get their periods back.
Defining Premenopause, Perimenopause, and Menopause
Effect on Sex
Chemo has different side effects that can have an impact onlibido(sexual desire), including fatigue, mouth soreness, neuropathy (nerve pain),nausea, decreased appetite, and pain. Anxiety ordepressioncan also affect your sex life and leave little energy for sex. Sexual desire often returns during recovery or in between cycles of treatments.
People getting chemo also tend to be sensitive about their appearance. Hair loss, weight loss or gain, and skin changes might occur, depending on the type of chemo you’re getting.
Some chemo drugs that irritate the mouth may also affect all mucous membranes, which line the inside of your hollow organs, like the gastrointestinal tract and respiratory tract. This includes the lining of thevagina, which may become dry and inflamed.
You could also experience flare-ups (intensification of symptoms) ofgenital wartsorherpesbecause of the immunosuppressive effect of chemotherapy drugs. Even if you have never had a flare, some people experience them for the first time while the body’s immune system is suppressed during chemo.
The Sexual Side Effects of Chemotherapy
Types of Chemo Medications
Chemo drugs that have been linked to the risk of infertility in females include:
Some chemo drugs have a lower risk of causing infertility in females. They include:
Talk to your healthcare provider about the chemo drugs you will get and the fertility risks that come with them.
Chemotherapy and Birth Defect Link
There is a substantial risk of children being born with birth defects because of chemotherapy.
Particularly during the first trimester, chemotherapy greatly increases the risk of malformations.Even in the second and third trimesters, chemotherapy increases the risk of pregnancy complications and a compromised immune system in babies after birth.
It’s important to use birth control methods during treatment for chemotherapy, but avoid the pill. Chemotherapy can causenausea, and vomiting may decrease the pill’s effectiveness.
Experts also recommend avoiding hormonal birth control containing estrogen. You may want to discussprogestin-only birth controlwith your healthcare provider.
Thecopper IUD(intrauterine device) is recommended for most females undergoing chemotherapy.
How to Talk to Your Healthcare Provider About Birth Control
Making a Fertility Plan Before Chemotherapy
Fertility specialists, such as reproductive endocrinologists or reproductive immunologists, can help those undergoing chemotherapy develop a fertility plan. Yourprimary care physician,gynecologist(a doctor specializing in female reproductive health), oroncologist(a cancer specialist) may be able to refer you to an appropriate specialist.
Fertility preservation is an important consideration for people who wish to have children after chemotherapy. You may wish to discuss cryopreservation of embryos or oocytes with your healthcare provider before beginning chemotherapy.
A fast-freezing method called vitrification has demonstrated increased pregnancy success over older, slow-freezing methods.Freezing your eggs in your 20s and early 30s gives you the opportunity to use your young eggs later in life.
If you freeze eggs between treatments or shortly after treatments, it is recommended that they be screened for potential birth defects.
Another option is ovarian tissue cryopreservation, which involves removing the egg-producing portion of the ovary, called the ovarian cortex, before treatment, and then freezing and storing it. The tissue can be transplanted years later to make pregnancy possible. This preservation method is the recommended option if the chemotherapy treatment is urgent and cannot be delayed.
Coping with Hormonal Changes After Chemo
If you just finished chemo and are now going through menopause, it is likely that you are experiencing intense emotional and physical changes. Perhaps this is not what you were expecting at this phase in your life, and you could be feeling alone, uncomfortable, panicked, angry, or afraid.
There are some lifestyle changes that can help you work through these changes, including:
Summary
Chemotherapy can negatively affect fertility in some people. Even if your fertility remains or returns to normal after treatment, it’s recommended that you wait for some time before trying to get pregnant. Chemotherapy is an effective treatment that can kill cancer cells, but it can also affect the development of embryos. You should discuss and develop a fertility plan with your healthcare provider before undergoing treatment.
A Word From Verywell
There are significant risk factors and side effects of chemo on female sexual health. This can be very challenging, but there are steps you can take to buffer against added stress. Talking with your healthcare provider about a fertility plan, joining a support group, and sharing your diagnosis with loved ones can help as you go through treatment.
Family planning prior to chemotherapy can be emotionally taxing. Therefore, it can be beneficial to speak to a therapist who specializes in the unique challenges that this presents for both you and, if applicable, your partner.
Frequently Asked QuestionsChemotherapy causes damage to your organs, including the ovaries, which can result in irregular or missed periods. Not everyone experiences this during chemotherapy, and some medications are more likely to cause it than others. Most people who experience a lost period during chemotherapy resume periods after treatment ends, but this depends on your age and treatment dosage.“Chemopause” is a term for the temporary induction of menopause during chemotherapy. With chemopause, periods eventually return. This may also be referred to as secondary amenorrhea. Certain chemotherapy medications are more likely to cause early menopausal symptoms. A person diagnosed with cancer in their 40s may start menopause sooner than someone in their 20s or 30s. You may experience hot flashes, mood changes, and sleep problems if you have chemopause.It is possible to get pregnant after chemotherapy ends, but chemotherapy causes damage to the ovaries, making it difficult or impossible to get pregnant during and shortly after treatment. However, damaged eggs are eliminated with time, meaning that waiting longer after treatment to get pregnant will generally result in improved chances for a healthy pregnancy.In fact, a study of 4,922 births among cancer survivors revealed that higher-risk preterm births were more common in women who became pregnant sooner after treatment ended than those who waited longer.Low platelets occur due to bone marrow damage during chemotherapy treatment, and spotting in between your menstrual cycle is normal. However, if you experience an abnormal amount of heavy bleeding, contact your healthcare provider right away.
Frequently Asked Questions
Chemotherapy causes damage to your organs, including the ovaries, which can result in irregular or missed periods. Not everyone experiences this during chemotherapy, and some medications are more likely to cause it than others. Most people who experience a lost period during chemotherapy resume periods after treatment ends, but this depends on your age and treatment dosage.
“Chemopause” is a term for the temporary induction of menopause during chemotherapy. With chemopause, periods eventually return. This may also be referred to as secondary amenorrhea. Certain chemotherapy medications are more likely to cause early menopausal symptoms. A person diagnosed with cancer in their 40s may start menopause sooner than someone in their 20s or 30s. You may experience hot flashes, mood changes, and sleep problems if you have chemopause.
It is possible to get pregnant after chemotherapy ends, but chemotherapy causes damage to the ovaries, making it difficult or impossible to get pregnant during and shortly after treatment. However, damaged eggs are eliminated with time, meaning that waiting longer after treatment to get pregnant will generally result in improved chances for a healthy pregnancy.In fact, a study of 4,922 births among cancer survivors revealed that higher-risk preterm births were more common in women who became pregnant sooner after treatment ended than those who waited longer.
It is possible to get pregnant after chemotherapy ends, but chemotherapy causes damage to the ovaries, making it difficult or impossible to get pregnant during and shortly after treatment. However, damaged eggs are eliminated with time, meaning that waiting longer after treatment to get pregnant will generally result in improved chances for a healthy pregnancy.
In fact, a study of 4,922 births among cancer survivors revealed that higher-risk preterm births were more common in women who became pregnant sooner after treatment ended than those who waited longer.
Low platelets occur due to bone marrow damage during chemotherapy treatment, and spotting in between your menstrual cycle is normal. However, if you experience an abnormal amount of heavy bleeding, contact your healthcare provider right away.
15 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Bedoschi G, Navarro PA, Oktay K.Chemotherapy-induced damage to ovary: mechanisms and clinical impact.Future Oncol. 2016 Oct;12(20):2333-44. doi:10.2217/fon-2016-0176Ruddy KJ, Partridge AH.Fertility (male and female) and menopause.J Clin Oncol. 2012;30(30):3705-3711. doi:10.1200/JCO.2012.42.1966National Cancer Institute.Radiation therapy to treat cancer.Klein DA, Paradise SL, Reeder RM.Amenorrhea: A Systematic Approach to Diagnosis and Management.Am Fam Physician. 2019;100(1):39-48. PMID: 31259490.Jacobson MH, Mertens AC, Spencer JB, Manatunga AK, Howards PP.Menses resumption after cancer treatment-induced amenorrhea occurs early or not at all.Fertil Steril. 2016;105(3):765-772.e4. doi:10.1016/j.fertnstert.2015.11.020American Cancer Society.How hormone therapy and chemo can affect the sex life of females with cancer.Breastcancer.org.How menopause can happen with breast cancer treatments.Ramirez-Fort MK, Zeng J, Feily A, et al.Radiotherapy-induced reactivation of neurotrophic human herpes viruses: Overview and management.J Clin Virol. 2018;98:18-27. doi:10.1016/j.jcv.2017.11.004Arnon J, Meirow D, Lewis-Roness H, Ornoy A.Genetic and teratogenic effects of cancer treatments on gametes and embryos.Human Reproduction Update. 2001;7(4):394-403. doi: 10.1093/humupd/7.4.394Konc J, Kanyó K, Kriston R, Somoskői B, Cseh S.Cryopreservation of embryos and oocytes in human assisted reproduction.Biomed Res Int. 2014;2014:307268. doi:10.1155/2014/307268Simopoulou M, Sfakianoudis K, Bakas P, et al.Postponing pregnancy through oocyte cryopreservation for social reasons: considerations regarding clinical practice and the socio-psychological and bioethical issues involved.Medicina. 2018;54(5):76. doi:10.3390/medicina54050076Harada M, Osuga Y.Fertility preservation for female cancer patients.Int J Clin Oncol. 2019;24(1):28-33. doi: 10.1007/s10147-018-1252-0American Cancer Society.Eating well after treatment.Hartnett, K. P., Mertens, A. C., Kramer, M. R., Lash, T. L., Spencer, J. B., Ward, K. C., & Howards, P. P.Pregnancy after cancer: Does timing of conception affect infant health?: Pregnancy Timing After Cancer.Cancer. 2018;124(22):4401-4407. doi: 10.1002/cncr.31732Bates JS, Buie LW, Woodis CB.Management of menorrhagia associated with chemotherapy-induced thrombocytopenia in women with hematologic malignancy.Pharmacotherapy. 2011;31(11):1092-1110. doi:10.1592/phco.31.11.1092
15 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Bedoschi G, Navarro PA, Oktay K.Chemotherapy-induced damage to ovary: mechanisms and clinical impact.Future Oncol. 2016 Oct;12(20):2333-44. doi:10.2217/fon-2016-0176Ruddy KJ, Partridge AH.Fertility (male and female) and menopause.J Clin Oncol. 2012;30(30):3705-3711. doi:10.1200/JCO.2012.42.1966National Cancer Institute.Radiation therapy to treat cancer.Klein DA, Paradise SL, Reeder RM.Amenorrhea: A Systematic Approach to Diagnosis and Management.Am Fam Physician. 2019;100(1):39-48. PMID: 31259490.Jacobson MH, Mertens AC, Spencer JB, Manatunga AK, Howards PP.Menses resumption after cancer treatment-induced amenorrhea occurs early or not at all.Fertil Steril. 2016;105(3):765-772.e4. doi:10.1016/j.fertnstert.2015.11.020American Cancer Society.How hormone therapy and chemo can affect the sex life of females with cancer.Breastcancer.org.How menopause can happen with breast cancer treatments.Ramirez-Fort MK, Zeng J, Feily A, et al.Radiotherapy-induced reactivation of neurotrophic human herpes viruses: Overview and management.J Clin Virol. 2018;98:18-27. doi:10.1016/j.jcv.2017.11.004Arnon J, Meirow D, Lewis-Roness H, Ornoy A.Genetic and teratogenic effects of cancer treatments on gametes and embryos.Human Reproduction Update. 2001;7(4):394-403. doi: 10.1093/humupd/7.4.394Konc J, Kanyó K, Kriston R, Somoskői B, Cseh S.Cryopreservation of embryos and oocytes in human assisted reproduction.Biomed Res Int. 2014;2014:307268. doi:10.1155/2014/307268Simopoulou M, Sfakianoudis K, Bakas P, et al.Postponing pregnancy through oocyte cryopreservation for social reasons: considerations regarding clinical practice and the socio-psychological and bioethical issues involved.Medicina. 2018;54(5):76. doi:10.3390/medicina54050076Harada M, Osuga Y.Fertility preservation for female cancer patients.Int J Clin Oncol. 2019;24(1):28-33. doi: 10.1007/s10147-018-1252-0American Cancer Society.Eating well after treatment.Hartnett, K. P., Mertens, A. C., Kramer, M. R., Lash, T. L., Spencer, J. B., Ward, K. C., & Howards, P. P.Pregnancy after cancer: Does timing of conception affect infant health?: Pregnancy Timing After Cancer.Cancer. 2018;124(22):4401-4407. doi: 10.1002/cncr.31732Bates JS, Buie LW, Woodis CB.Management of menorrhagia associated with chemotherapy-induced thrombocytopenia in women with hematologic malignancy.Pharmacotherapy. 2011;31(11):1092-1110. doi:10.1592/phco.31.11.1092
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Bedoschi G, Navarro PA, Oktay K.Chemotherapy-induced damage to ovary: mechanisms and clinical impact.Future Oncol. 2016 Oct;12(20):2333-44. doi:10.2217/fon-2016-0176Ruddy KJ, Partridge AH.Fertility (male and female) and menopause.J Clin Oncol. 2012;30(30):3705-3711. doi:10.1200/JCO.2012.42.1966National Cancer Institute.Radiation therapy to treat cancer.Klein DA, Paradise SL, Reeder RM.Amenorrhea: A Systematic Approach to Diagnosis and Management.Am Fam Physician. 2019;100(1):39-48. PMID: 31259490.Jacobson MH, Mertens AC, Spencer JB, Manatunga AK, Howards PP.Menses resumption after cancer treatment-induced amenorrhea occurs early or not at all.Fertil Steril. 2016;105(3):765-772.e4. doi:10.1016/j.fertnstert.2015.11.020American Cancer Society.How hormone therapy and chemo can affect the sex life of females with cancer.Breastcancer.org.How menopause can happen with breast cancer treatments.Ramirez-Fort MK, Zeng J, Feily A, et al.Radiotherapy-induced reactivation of neurotrophic human herpes viruses: Overview and management.J Clin Virol. 2018;98:18-27. doi:10.1016/j.jcv.2017.11.004Arnon J, Meirow D, Lewis-Roness H, Ornoy A.Genetic and teratogenic effects of cancer treatments on gametes and embryos.Human Reproduction Update. 2001;7(4):394-403. doi: 10.1093/humupd/7.4.394Konc J, Kanyó K, Kriston R, Somoskői B, Cseh S.Cryopreservation of embryos and oocytes in human assisted reproduction.Biomed Res Int. 2014;2014:307268. doi:10.1155/2014/307268Simopoulou M, Sfakianoudis K, Bakas P, et al.Postponing pregnancy through oocyte cryopreservation for social reasons: considerations regarding clinical practice and the socio-psychological and bioethical issues involved.Medicina. 2018;54(5):76. doi:10.3390/medicina54050076Harada M, Osuga Y.Fertility preservation for female cancer patients.Int J Clin Oncol. 2019;24(1):28-33. doi: 10.1007/s10147-018-1252-0American Cancer Society.Eating well after treatment.Hartnett, K. P., Mertens, A. C., Kramer, M. R., Lash, T. L., Spencer, J. B., Ward, K. C., & Howards, P. P.Pregnancy after cancer: Does timing of conception affect infant health?: Pregnancy Timing After Cancer.Cancer. 2018;124(22):4401-4407. doi: 10.1002/cncr.31732Bates JS, Buie LW, Woodis CB.Management of menorrhagia associated with chemotherapy-induced thrombocytopenia in women with hematologic malignancy.Pharmacotherapy. 2011;31(11):1092-1110. doi:10.1592/phco.31.11.1092
Bedoschi G, Navarro PA, Oktay K.Chemotherapy-induced damage to ovary: mechanisms and clinical impact.Future Oncol. 2016 Oct;12(20):2333-44. doi:10.2217/fon-2016-0176
Ruddy KJ, Partridge AH.Fertility (male and female) and menopause.J Clin Oncol. 2012;30(30):3705-3711. doi:10.1200/JCO.2012.42.1966
National Cancer Institute.Radiation therapy to treat cancer.
Klein DA, Paradise SL, Reeder RM.Amenorrhea: A Systematic Approach to Diagnosis and Management.Am Fam Physician. 2019;100(1):39-48. PMID: 31259490.
Jacobson MH, Mertens AC, Spencer JB, Manatunga AK, Howards PP.Menses resumption after cancer treatment-induced amenorrhea occurs early or not at all.Fertil Steril. 2016;105(3):765-772.e4. doi:10.1016/j.fertnstert.2015.11.020
American Cancer Society.How hormone therapy and chemo can affect the sex life of females with cancer.
Breastcancer.org.How menopause can happen with breast cancer treatments.
Ramirez-Fort MK, Zeng J, Feily A, et al.Radiotherapy-induced reactivation of neurotrophic human herpes viruses: Overview and management.J Clin Virol. 2018;98:18-27. doi:10.1016/j.jcv.2017.11.004
Arnon J, Meirow D, Lewis-Roness H, Ornoy A.Genetic and teratogenic effects of cancer treatments on gametes and embryos.Human Reproduction Update. 2001;7(4):394-403. doi: 10.1093/humupd/7.4.394
Konc J, Kanyó K, Kriston R, Somoskői B, Cseh S.Cryopreservation of embryos and oocytes in human assisted reproduction.Biomed Res Int. 2014;2014:307268. doi:10.1155/2014/307268
Simopoulou M, Sfakianoudis K, Bakas P, et al.Postponing pregnancy through oocyte cryopreservation for social reasons: considerations regarding clinical practice and the socio-psychological and bioethical issues involved.Medicina. 2018;54(5):76. doi:10.3390/medicina54050076
Harada M, Osuga Y.Fertility preservation for female cancer patients.Int J Clin Oncol. 2019;24(1):28-33. doi: 10.1007/s10147-018-1252-0
American Cancer Society.Eating well after treatment.
Hartnett, K. P., Mertens, A. C., Kramer, M. R., Lash, T. L., Spencer, J. B., Ward, K. C., & Howards, P. P.Pregnancy after cancer: Does timing of conception affect infant health?: Pregnancy Timing After Cancer.Cancer. 2018;124(22):4401-4407. doi: 10.1002/cncr.31732
Bates JS, Buie LW, Woodis CB.Management of menorrhagia associated with chemotherapy-induced thrombocytopenia in women with hematologic malignancy.Pharmacotherapy. 2011;31(11):1092-1110. doi:10.1592/phco.31.11.1092
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