You may remember me posting a while back about the different ways I tried to protect my fertility as I prepared to start chemotherapy. First, I froze some eggs. In case I’m unable to conceive naturally later, I can use them for IVF. I also started monthly Zoladex injections – a medication that halts ovarian function in an attempt to preserve fertility overall.
And so, at age 31, I’ve been in a Zoladex-induced menopause since June. Six whole months later, my estrogen levels have tanked and my joints ache like I’m an 100-year-old lady! Some other fun side effects include amenorrhea (lack of a period), hot flashes, and dyspareunia. So, I’m currently staying as active as possible (mostly walking and stretching when I have the energy) in order to mitigate some of those side effects, and thankfully, my oncologist and I decided it was time to discontinue the Zoladex now that the bulk of treatment is behind me. Today marks one month since my last injection!
For more detailed info about fertility preservation, you can read my earlier post here.
What to expect now?
Typically, the menstrual cycle can take a few months to return as the body figures out its new normal once again. As I have some previous experience with amenorrhea after I came off the birth control pill in 2019, I know that what I eat will play a huge role in how quickly my body gets back to normal. Thus, the plant-based diet continues (plus no dairy, processed sugars, or alcohol) and I will try my absolute hardest to cut back on caffeine to keep my nervous system calm.
I also plan to use seed cycling to help my body regulate the essential hormones it needs for menstruation and ovulation. This is a great article about how to do seed cycling if you’re interested in learning more. Seed cycling is an excellent, natural way to balance hormones, however if you have hormone-positive cancer, please ask your doctor if a daily dose of phytoestrogens is safe for you!
Once I’ve completed radiation therapy, I’ll speak with my medical oncologist and OB/GYN about when it will be safe to start trying to conceive. With that said, I think my body deserves a long break to heal completely before that all happens. Actually, this might be a good time to kindly remind you that it’s just not acceptable to ask a person when they plan to have children. A person’s body is their own to make decisions for and, sometimes, people aren’t capable or willing to have children at all.
My goal for this blog has always been to be as open and honest about my experiences as possible in the hopes that whoever may be reading this can gain some insight for their own health and wellness. Personally, I don’t think there’s ever TMI (too much information) disclosed when it comes to learning about your own body and how it works. This coming from a pelvic floor PT who talks about poop all day… Anyway, I’d love to know what questions you have about:
On today’s blog, I wanted to bring attention to female pelvic pain and dyspareunia (pain with intercourse) secondary to cancer treatments.
Often, when a woman has gone through adjuvant hormonal treatments, chemotherapy, abdominal/pelvic radiation, or fertility-saving drugs during active treatment, the body goes into a state of menopause or “chemopause” as it’s commonly referred to in the cancer world.
Low estrogen levels during chemopause can cause symptoms like:
Amenorrhea (loss of menstrual cycle)
Vaginal dryness or atrophy
Joint aches and pains
In particular, vaginal dryness or atrophy can have a huge impact on sexual health, emotional health, and relationships post-cancer. If the pelvic floor muscles are compromised by treatment, it can result in pelvic pain (like pain from overactive or tight pelvic floor muscles, pain in the tailbone, lower abdominal pain, or pain around post-surgical scars), bladder/bowel changes, or painful sex.
Thankfully, a pelvic floor physical therapist with specialized training in examination and treatment of the pelvic floor muscles can treat these conditions and are an amazing asset to oncology patients on their road to recovery. Some PT treatments for pelvic pain and dyspareunia may involve:
Pelvic floor muscle strengthening or relaxation exercises with or without biofeedback training (computer or ultrasound-based pelvic floor training technology)
Stretches for tight muscles around the abdomen, pelvis or hips
Manual therapy including general massage, pelvic floor muscle release techniques, or scar tissue mobilization
Education and lifestyle strategies surrounding posture, nutrition, bowel and bladder habits, and lubrication options during intercourse
Education in the use of vaginal dilators to reduce pain that occurs with tampon insertion, gynecological exams, or sex
Encouragement around body image and sexual health (this could include referral to a sex therapist or psychologist when appropriate)
If you’re reading this, and you feel like you could benefit from pelvic floor physical therapy during or after cancer treatment, you can find a qualified pelvic floor PT in your area here or here. Ask your doctor for a referral today!
And a quick reminder for all of us… The path to recovery from cancer involves a whole host of treatments including chemo, hormonal treatments, surgery, and radiation just to name a few. Each of these treatments can come with significant side effects or long-lasting comorbidities. Just because someone is “cured” from cancer doesn’t always mean they are living without long-term effects from treatment. Keep this in mind, and be kind!
*This blog is part 2 of Pink October’s Pelvic Floor Series, a way to raise awareness of pelvic floor problems during cancer treatment and discuss sex & intimacy after a cancer diagnosis.
When the last thing you expect is to be diagnosed with breast cancer at age 30 (or under 40, honestly), your desire to have (or not have) future children becomes very clear suddenly. I may have been the person who was in no rush to have kiddos, but I took it pretty hard knowing I was about to start chemotherapy that would significantly affect my ability to reproduce, possibly even making it impossible to conceive naturally.
In all the rush of my initial diagnosis, I wasn’t able to write about options to preserve fertility during chemotherapy. Honestly, it was some of the most emotional decision-making I had to do at the time, so maybe I put it off because it was all very overwhelming! Ultimately, I made two important decisions in order to help save my fertility, which I’ll share below with a few other important concepts regarding fertility preservation.
Chemotherapy & Its Effect on the Ovaries
First, you may wonder how exactly chemotherapy affects your ovaries. Chemo medications are designed to target and kill rapidly dividing cancer cells. Unfortunately, those meds can’t differentiate between rapidly dividing cancer cells and rapidly dividing normal cells in the skin, digestive tract, and reproductive organs. Just as you’d expect to see some side effects like skin/nail changes or mouth sores, we expect to see some attack on the ovaries as they also have a known cycle of cell turnover (a.k.a. ovulation). Thus, if you’ve never had children, and your cancer is stable enough to delay treatment for a few weeks to a month, your doctor should recommend all of the fertility-preservation options they have available. If they don’t offer, you better ask!
Egg Preservation Prior to Active Treatment
I was referred to a fertility specialist/reproductive endocrinologist who was excellent. I had the option to extract eggs (unfertilized) or embryos (fertilized) which would be frozen by a process called vitrification until I need them at a later date. I chose to freeze eggs as research now shows no major difference in later IVF success rates whether an egg or embryo is used, per my physician.
The whole process is timed with the menstrual cycle, so specific hormones are injected during the follicular phase (when the ovarian follicles that store the eggs begin to grow and mature) beginning on day 2 or 3 of menstruation. The fertility specialists monitor follicle growth and count every few days with a pelvic ultrasound and bloodwork. As the follicles mature, indicating ovulation to be close, a different medication is given to delay ovulation until the mature eggs can be retrieved.
The retrieval process is done under light anesthesia in the fertility office. A needle is directed into each ovary through the back of the vaginal vault. Suction is used to retrieve the mature follicles, and after inspection of all eggs to determine which are viable, the eggs can be fast frozen (“vitrified”) and stored in an egg bank until needed. Voila! Now, I have a back-up option post-cancer if I’m unable to conceive naturally! Thank goodness for modern medicine.
Throughout all of that, the worst side effects I had were some moderate bloating and cramping after the egg retrieval. I was also given a separate hormone during the follicle-stimulating phase that helped to avoid an estrogen spike so my mood remained stable throughout (I’m sure my husband appreciated that I wasn’t a hormonal monster through it all). Despite having to delay chemo about 4 weeks to complete this process (remember, they like to time it with your natural cycle), I have no regrets on completing this first for peace of mind alone.
The Cost of Fertility Preservation
Whoever my future kids are, I hope they know I reallllllyyyy want them, because fertility options are not cheap! Most insurances do not cover egg/embryo preservation if you do not have a diagnosis of “infertility” even if you get cancer that you never wanted which might render you infertile… (I’ll refrain from saying any more). The egg retrieval process alone usually costs somewhere around $10k which doesn’t include the annual storage fee for the eggs (mine is about $700 per year).
Fortunately, there is a great option for cancer thrivers through the Livestrong Foundation. My fertility specialist had me begin paperwork to apply for their grant which covers about 1/3 of the total cost if you qualify (most cancer patients do unless your insurance covers). Ask your fertility doc if this is an option for you!
Options to Preserve Ovarian Function during Chemo
Besides the pre-treatment egg retrieval, my medical oncologist also recommended that I go on a gonadotropin-releasing hormone (GnRH) agonist called Zoladex during chemo. This is a monthly injection that essentially halts ovarian function by blocking GnRH (a hormone released from the hypothalamus in the brain that triggers the release of follicle-stimulating and leutinizing hormones which act directly on the ovaries). The cancer community “lovingly” refers to this state of no periods as “chemopause” because it is essentially a medically-induced menopause complete with joint aches and hot flashes. I have been lucky that my side effects have been mild, and I’m very thankful to give my reproductive system this brief pause while I kick cancer’s ass.
After treatment, once I get the ok from docs, I’ll still be able to try to conceive naturally. The chances of conceiving naturally are lower for those of us who’ve gone through chemo or radiation, but it’s definitely possible! If I need a little help, then I’ve got a few tiny frozen eggs lined up for further fertility treatments down the line.
It’s Okay to Be Concerned about Your Fertility
I’m thankful that my OB/GYN and oncology team were very supportive about fertility preservation prior to starting active treatment. For many women, hearing your plans for a family will likely have to change after cancer is devastating. I didn’t expect to be so emotional about this whole process, to be honest. I’ve always wanted kids some day, but I wasn’t a person who constantly planned my life around it. Even still, early into my diagnosis, I found myself mourning the loss of my potential fertility more than the fact that I could die from cancer. I don’t believe it does anyone any good to stop planning for the future and let cancer have all the control, so be sure to tell your doctors how important saving your reproductive health is to you!
My heart goes out to anyone reading this and going through the same decision-making process. My heart goes out to those of you reading this who are struggling to conceive even without a cancer diagnosis. I’m so thankful to have so many options to consider and know that, in the right time, children will be a part of my journey, too. For those of you just starting out on your cancer and fertility journey, be sure to ask your doctors what the best options are for you!