Lisa Ray Struggled With Early Menopause At 37: Doctor Explains How Chemotherapy Affects Fertility In Women

In 2009, Lisa Ray, a Canadian actress, was diagnosed with multiple myeloma, a rare blood cancer that affects plasma cells in the bone marrow. Three years after recovery, she relapsed in 2012, which she fought with a combination of treatments. Recently, in a social media post, Lisa Ray opened up about the struggle with early menopause at 37. "At 37, chemo pushed me into early menopause. I was told - almost casually - that the treatment saving my life would also end my fertility. No roadmap. No conversation about HRT. No emotional support. Just headlines screaming fear about hormones and cancer, and a body I suddenly didn't recognise," she wrote in an Instagram post.

"I was completely unprepared. I suffered for many years silently. I also had shame and stigma. And I couldn't even explain to myself, and I imbibed the shame of hitting menopause," she told the BBC in an interview.

Menopause, which typically affects women in their 40s or 50s, is a natural part of ageing. It marks the end of a woman's reproductive years. It occurs when the ovaries stop producing reproductive hormones. Hormonal changes during menopause can cause some unpleasant symptoms, including irregular periods, hot flashes, night sweats and vaginal dryness. It can also affect mood, causing irritability, mood swings, anxiety, depression, and brain fog. Sleep issues and weight gain are also common during menopause.

Early menopause due to chemotherapy

Menopause can begin early due to surgery or medical treatment, which is called induced menopause. Chemotherapy can induce early menopause, often called chemopause, by damaging the ovaries and reducing the number or maturation of eggs. This process can be sudden, occurring within a few months of treatment, which often leads to more severe symptoms than natural, gradual menopause. Therefore, chemo-induced menopause can be hard and extremely challenging for cancer patients.

What this happens?

Chemotherapy targets cells that grow and divide quickly. This means it kills both cancerous and healthy cells throughout the body, like the ones your body uses to grow hair. This side effect of chemo also affects the reproductive organs, including your ovaries, along with hormones. As a result, chemo can affect levels of estrogen and progesterone in the body, triggering the onset of menopause.

"Chemotherapy is intended to target rapidly proliferating cancer cells, but it can also impact other fast growing cells in the body, such as those in the ovaries. The ovaries are home to a limited number of eggs and hormone-secreting cells; when these cells are damaged by chemotherapy medications, the secretion of hormones ceases drastically. This abrupt cessation of estrogen and progesterone hormone secretion leads to menopause, which occurs much earlier than the usual age of menopause (between 45-55 years). If this happens before the age of 40 years, it is known as premature ovarian insufficiency (POI), and if it happens before the age of 45 years, it is called early menopause," explains Dr. Indoo Ammbulkar, Director Medical Oncology at HCG Caner Centre, Borivali.

What are the symptoms of chemo-induced menopause?

The symptoms of chemotherapy-induced menopause are similar to natural menopause, but can feel more extreme due to the rapid drop in hormone levels.

Common symptoms include:

• Physical: Severe hot flashes, night sweats, vaginal dryness, weight gain, and joint pain
• Emotional changes: Mood swings, anxiety, depression, and brain fog
• Long-term risks: Increased risk of osteoporosis (bone thinning), cardiovascular disease, and permanent infertility

Is it permanent?

"The same damage to the ovaries that leads to early menopause also causes infertility. Chemotherapy can decrease the number of healthy eggs and damage the ovaries' reserve, potentially resulting in temporary or permanent infertility. The risk of permanent infertility is higher with higher doses of chemotherapy, certain medications (such as alkylating agents), and older age at the time of chemotherapy," Dr. Ammbulkar explains.

Whether chemo-induced menopause is temporary or permanent depends on several factors:

1. Age

Younger women (under 35) are more likely to regain their periods after treatment, as the risk of permanent menopause increases significantly for those over 40.

2. Chemotherapy type

Some chemotherapeutic agents carry the highest risk of ovarian damage.

3. Dosage

Higher cumulative doses and combined treatments like chemo + radiation increase the likelihood of permanent menopause.

Management tips:

Management of chemo-induced menopause requires both medical and non-medical approaches. Dr. Ammbulkar shares the following tips:

• Medical management: In selected patients and if possible, hormone replacement therapy (HRT) or menopausal hormone therapy may be employed to alleviate symptoms and prevent bone and cardiovascular disorders. Nonetheless, HRT is not generic for all women and depends on the type of cancer and risk factors. Non-hormonal medications can also be used for the control of hot flashes and mood changes.
• Fertility planning: Pre-cancer treatment planning with a fertility specialist for the harvesting of eggs or embryos may be very helpful.
• Healthy living: Stress reduction, vitamin D and calcium supplements, exercise, and good sleep habits can all help lower symptoms and avoid problems like osteoporosis.
• Psychosocial treatment options: Medical professionals, support groups, and counselling can all be used to effectively treat early menopause, infertility, and changes in body image.

How to preserve fertility during cancer treatment

To preserve fertility when facing early menopause from chemotherapy, it is critical to act before treatment begins. Chemotherapy can damage or destroy the eggs in the ovaries, leading to a permanent loss of fertility or significantly early menopause. Egg freezing is one of the most common and successful methods which can help preserve fertility. It typically requires 2-3 weeks of hormonal stimulation to produce multiple eggs.

"Chemotherapy-induced early menopause is a severe medical complication of cancer that has physical and psychological impacts. With careful planning and communication, women can cope with symptoms, preserve their health, and make informed decisions about their reproductive and life choices," Dr. Ammbulkar advises.

Disclaimer: This content including advice provides generic information only. It is in no way a substitute for a qualified medical opinion. Always consult a specialist or your own doctor for more information. NDTV does not claim responsibility for this information.