What Happens to Your Period After Chemo?

Answers to Questions About Chemotherapy and Reproductive Health

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Chemotherapy is a form of treatment for cancer. It is a group of medications used to kill cancer cells. Following chemotherapy, people with a uterus may experience changes in their libido (sex drive) and fertility.

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 a woman is likely to be fertile after chemo.

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Chemotherapy and Ovarian Function

Chemotherapy can damage the female reproductive system, including the reproductive organs and the hypothalamic-pituitary axis, which is responsible for hormonal regulation.

The hormones that are needed to release eggs each month, such as estrogen, and prepare the uterus for a possible pregnancy are made in the cells of the ovaries called oocytes.

Oocytes tend to divide quickly, so they are often affected by chemo, which kills fast-growing cells. This can lead to loss of those important hormones and can affect fertility. Sometimes a woman will go into premature or early menopause after chemo.

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 and radiation therapy to 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.

Effect on Menstruation

Amenorrhea is the absence of a period, or menses. There are two types of amenorrhea, which include:

  • Primary amenorrhea: This is defined as lack of a period by age 15, or two years after puberty, which is marked by the onset of breast development in females.
  • Secondary amenorrhea: Secondary amenorrhea is the absence of periods for three months or having irregular periods for six months. Causes can include stress, low body weight, certain medications, overexercising, or eating disorders. It can also be caused by polycystic ovary syndrome (PCOS), or uterine scarring. Chemotherapy-induced amenorrhea is considered a type of secondary amenorrhea.

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 cause a female to have a higher risk for infertility, and others that might not affect fertility at all, such as:

  • Age: The younger you are, the more eggs you have in your ovaries. This gives you a higher chance of preserving some fertility despite damage from treatments. Women who are treated for cancer before they are 35 years old have the best chance of becoming pregnant after treatment.
  • Puberty and menopause: Girls who had chemo before puberty or young women whose periods start again after chemo are at risk of premature menopause. This is when a woman stops having periods before age 40. It's also called premature ovarian failure or primary ovarian insufficiency. Infertility occurs because the ovaries stop making the hormones needed for fertility.

It's important to remember that even if a woman’s periods start again after cancer treatment has stopped, her 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 an unborn baby. Women are usually 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 as medical 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:

  • Cyclophosphamide, Adriamycin (doxorubicin), and Tolak (fluorouracil) topical cream
  • Cyclophosphamide, Ellence (epirubicin), and fluorouracil
  • Doxorubicin and cyclophosphamide
  • Taxotere (Docetaxel), doxorubicin, and cyclophosphamide

Even if your periods continue during chemo, you may have menopausal symptoms. It’s similar to being in the state called perimenopause, 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.

Effect on Sex 

Chemo has different side effects that can have an impact on libido (sexual desire), including fatigue, mouth soreness, neuropathy (nerve pain), nausea, decreased appetite, and pain. Anxiety or depression can also affect your sex life and leave little energy for sex. Sexual desire often returns when a woman feels better 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 outside of your organs, in the body. This includes the lining of the vagina, which may become dry and inflamed.

You could also experience flare-ups (intensification of symptoms) of genital warts or herpes because 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.

Types of Chemo Medications 

Chemo drugs that have been linked to the risk of infertility in females include:

  • Busulfan
  • Carboplatin
  • Carmustine
  • Chlorambucil
  • Cisplatin
  • Cyclophosphamide
  • Cytosine arabinoside
  • Doxorubicin
  • Ifosfamide
  • Lomustine
  • Melphalan
  • Mitomycin-C
  • Nitrogen mustard (mechlorethamine)
  • Procarbazine
  • Temozolomide
  • Thiotepa
  • Vinblastine
  • Vincristine

Some chemo drugs have a lower risk of causing infertility in females. They include:

  • 5-fluorouracil (5-FU)
  • 6-mercaptopurine (6-MP)
  • Bleomycin
  • Cytarabine
  • Dactinomycin
  • Daunorubicin
  • Epirubicin
  • Etoposide (VP-16)
  • Fludarabine
  • Gemcitabine
  • Idarubicin
  • Methotrexate

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 the baby being born with a compromised immune system.

It’s important to use birth control methods during treatment for chemotherapy, but avoid the pill. Chemotherapy can cause nausea, and vomiting may decrease the pill's effectiveness.

Experts also recommend avoiding hormonal birth control containing estrogen. You may want to discuss progestin-only birth control with your healthcare provider.

The copper IUD (intrauterine device) is recommended for most women undergoing chemotherapy.

Making a Fertility Plan Before Chemotherapy 

Fertility specialists, such as reproductive endocrinologists or reproductive immunologists, can help those undergoing chemotherapy develop a fertility plan. Your primary care physician, gynecologist (a doctor specializing in female reproductive health), or oncologist (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 a patient’s treatment, freezing it, 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:

  • Eat a healthy diet.
  • Avoid alcohol and processed meats.
  • Engage in light-to-moderate exercise regularly.
  • Practice yoga, mindfulness, and meditation.
  • Join a support group.
  • Unwind and take your mind off stressful topics through a new hobby.
  • Be patient and open to new approaches to sex and intimacy. Explore alternatives such as massage or cuddling.
  • Get plenty of sleep.

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 Questions

  • How does chemotherapy affect your period?

    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.

  • What is chemopause?

    "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 woman who is diagnosed with cancer in her 40s may start menopause sooner than a woman in her 20s or 30s. You may experience hot flashes, mood changes, and sleep problems if you have chemopause.

  • Can you get pregnant after chemotherapy?

    It is possible to get pregnant after chemotherapy ends, but chemotherapy causes damage to the ovaries, making it difficult or impossible for many women 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.

  • Is spotting after chemotherapy normal?

    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.

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