A lump or alteration in the size or shape of the breast is not the sole manifestation of breast cancer's effects. This prevalent form of cancer among women, along with its treatment, can influence menstrual health. While the cancer itself may not directly disrupt menstrual cycles, the various treatment modalities may result in amenorrhea, characterized by the absence of menstruation. Moreover, there may be a correlation between menstrual cycles and the risk of developing breast cancer. October, designated as Breast Cancer Awareness Month, serves as an opportune moment to examine the relationship between breast cancer and menstrual health.

What is breast cancer?  

Breast cancer is defined as a malignant tumour that arises from the cells within breast tissue. It typically originates in the breast and has the potential to metastasize to other areas of the body, as noted by the UK's National Health Service. In 2022, breast cancer was identified as the most prevalent cancer among women in 157 countries, resulting in approximately 670,000 fatalities worldwide, according to the World Health Organization. This condition can affect women of any age post-puberty, with the likelihood increasing as they grow older. Several risk factors are associated with this type of cancer.

• Increasing age
• Obesity
• Harmful use of alcohol
• Family history of breast cancer
• A history of exposure to radiation

Breast lump is one of the symptoms of breast cancer. Image courtesy: Adobe Stock

What are the symptoms of breast cancer?

Symptoms of breast cancer include:

• A breast lump, may feel hard, irregular in shape, and a bit different from the rest of the breast tissue
• Swelling or shrinking of just one breast
• Nipple changes like inversion or discharge
• Breast skin changes like dimpling or redness or appearing more like an orange peel
• Breast or nipple pain

Some women may not experience noticeable symptoms of breast cancer, which is why regular breast exams and mammograms are essential for early detection.

How does breast cancer affect periods?

Breast cancer itself may not directly affect a woman's menstrual cycle; however, the treatments employed to combat this disease can have a significant impact on hormonal equilibrium, which may, in turn, influence menstrual patterns, according to obstetrician and gynecologist Dr. Chetna Jain.

The following outlines how breast cancer treatments can alter menstruation:

1. Chemotherapy  

Chemotherapy, a prevalent treatment for breast cancer, utilizes potent medications to target rapidly dividing cells, including cancerous ones. Unfortunately, these drugs can also impact ovarian function, potentially resulting in temporary amenorrhea. A study published in the Breast Cancer Research and Treatment journal in 2020 revealed that 76 per cent of participants experienced chemotherapy-induced amenorrhea, with only 40 per cent resuming their menstrual cycles post-treatment. Dr. Jain notes that in some women, particularly those nearing natural menopause (typically in their 40s or older), chemotherapy may lead to permanent ovarian failure, resulting in early menopause and the irreversible cessation of menstruation. Additionally, chemotherapy may cause some women to experience irregular, less frequent, or heavier menstrual periods.

2. Hormone therapy  

Hormonal treatments, such as Tamoxifen or Aromatase Inhibitors, are frequently prescribed for women with hormone receptor-positive breast cancer to inhibit estrogen or lower its levels in the body. These therapies can lead to irregular menstrual cycles, alterations in flow, or even complete cessation of menstruation in certain women, particularly those approaching menopause.

3. Ovarian suppression  

In certain instances, breast cancer treatment may include ovarian suppression to decrease estrogen levels in the body. Dr. Jain explains that medications like Goserelin (Zoladex) can be utilized to temporarily "shut down" ovarian function, halting estrogen production. This intervention may result in a temporary cessation of menstruation, simulating menopausal symptoms.

4. Radiation therapy

Most women who undergo radiation therapy typically resume menstruation within a two-year period. However, once menstruation is reestablished, older women may experience irregular cycles, according to research published in the journal Fertility and Sterility in 2017. Radiation therapy directed at the breast generally does not impact menstrual cycles; however, radiation to other regions, such as the pelvis, can adversely affect the ovaries and result in changes to menstrual patterns.

Can menstrual history influence breast cancer risk? 

Indeed, a woman's menstrual history is considered a contributing factor to breast cancer risk, according to experts. A study published in Frontiers in Oncology in 2016 identified a significant correlation between the timing of the onset and cessation of menstrual cycles and an increased risk of breast cancer. The research indicated that for each year a girl begins menstruating earlier, there is a 5 per cent increase in the likelihood of developing breast cancer later in life.

The risk of breast cancer is associated with the duration of estrogen exposure, which promotes the growth of breast cells. Over time, this exposure can affect the development of cancerous cells, as noted by Dr. Jain. Consequently, women who experience their first menstruation before the age of 12 face a heightened risk of breast cancer due to prolonged estrogen exposure. Additionally, older women who reach menopause after the age of 55 are also at an elevated risk due to the extended duration of estrogen exposure, as explained by the expert.

Menstrual history and breast cancer have a link. Image courtesy: Freepik

What to do if you lose your period during breast cancer treatment?

Losing your period during breast cancer treatment can be distressing, but it is a common side effect. Here's what to do:

• Discuss your concerns with your doctor, who can explain whether your amenorrhea is temporary or permanent based on factors like your treatment regimen, and age.
• If you are concerned about fertility, talk to a fertility specialist before starting breast cancer treatment. Options like egg or embryo freezing can be considered to preserve fertility before chemotherapy or hormone therapy.
• If periods do not return, early menopause can lead to decreased bone density. Your doctor may tell you to take calcium and vitamin D supplements to support bone health.
• Maintaining a healthy lifestyle, including a balanced diet, regular physical activity, and managing stress, can help deal with the side effects of period loss and treatment.

The relationship between breast cancer and menstruation may not be straightforward. However, it is possible to experience the cessation of menstrual cycles during breast cancer treatment, which can be distressing. It is crucial to maintain focus on the overarching objective of the treatment.

Read Also: Is Scheduled Sex Beneficial or Detrimental to Intimacy? Exploring the Pros and Cons

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