Coping With Breast Cancer Treatment and Early Menopause

As the daughter of a breast cancer survivor, Bahar has always been careful to schedule mammograms and pay attention to how her breasts look and feel. Three years ago, at age 50, she found a lump in one of her breasts. She had a type of breast cancer that responds to the hormone estrogen, just as her mother had.

Estrogen-blocking medications are the usual chemotherapy for this type of cancer. But blocking estrogen’s activity can cause symptoms of menopause. In this edited interview, Bahar describes her journey through cancer treatment and menopause.

ACOG: How did you learn you had cancer, and what was the treatment?

Bahar: After I found the lump, I called my doctor. They sent me for a mammogram and said it looked normal. I still wanted them to do a biopsy.

I had tenderness in my armpit, so they biopsied that area too. It turned out the cancer had spread to my lymph nodes. My health care team did a lumpectomy and took out 27 lymph nodes, five of which were affected.

ACOG: When did you first think you might be in menopause?

Bahar: I had surgery in December, and a period immediately afterward. In January, I had my first chemotherapy, and I did not have any periods at all after that. They stopped completely.

ACOG: Did you have any menopausal symptoms before you learned you had breast cancer?

Bahar: I had been thinking about menopause because of my age, 50. But my primary care doctor and I had never really talked about it. I had regular periods with no issues or problems. My doctor thought I would probably be one of those women who has her period into her 50s.

ACOG: When was it confirmed that you had gone through menopause?

Bahar: After I finished chemo and my periods stopped, I started taking a medication called tamoxifen. Tamoxifen is an estrogen blocker, so even if I had been getting my period, I think tamoxifen would have stopped it.

Tamoxifen did not agree with me, so I told the doctors I would like to try another treatment. Before they could do that, they had to do a blood test for hormone levels. Based on the results, they said I was officially menopausal.

ACOG: What menopausal symptoms did you notice at that point?

Bahar: Other than my periods stopping, I didn’t have any symptoms until I started taking anastrozole, another type of medication that lowers estrogen levels. When I started taking it, my menopause symptoms immediately bloomed. I finally knew what a hot flash felt like! I had them almost every day. I was turning on the fans, opening the windows, and waking up at night soaked in sweat.

[Read What can I do to help with hot flashes?]

ACOG: How long did the symptoms last?

Bahar: I eventually stopped taking anastrozole, and most of my symptoms went away then. All the hot flashes and other menopause symptoms have disappeared.

I still have some menopause symptoms, including memory issues. But chemo also causes memory issues—they call it “chemo brain”—so it’s hard to tell if those problems come from being menopausal or having had chemo. I teach Persian, and sometimes I can’t think of a Persian word my students are asking for—or the English translation, either. It’s frustrating.

ACOG: Have you made any lifestyle changes as part of your cancer treatment?

Bahar: Because my cancer responds to estrogen, I have to be very careful about what I eat. Some foods, like soy products, contain a type of plant-based estrogen that I have to avoid.

Lately, I’ve been trying other diet changes too. Sugars and carbs feed cancer cells, so my doctors encouraged low-carb eating. I lost quite a bit of weight with this diet before the COVID-19 pandemic, but I have gained some weight back during the pandemic.

My doctors also recommended that I take calcium and vitamin D supplements daily to help prevent bone loss. Bone loss is one of the main side effects of one of the medications I was taking.

ACOG: Is there anything you wish you’d known before you went through all of this?

Bahar: I wish I had been more proactive about my diet and exercise. I’m not really an overeater. I try to keep my calories under control. But because of my sedentary lifestyle, I have always been overweight. It’s also my body style.

I wish I had put myself on an exercise regimen from the very beginning so I could have a stronger body to deal with the things that are happening. My body was pretty strong, because the doctors were just amazed at how much chemo I could withstand. If I had exercised during that time, I think I could do more today.

I worked through my treatments. My doctors and nurses said it might be counterintuitive, but if you are feeling fatigued, get up and walk and do stuff as much as you can. I took very few hours off work, but I didn’t go to the gym. If I had it to do over, that’s what I would do.

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This information is designed as an educational aid for the public. It offers current information and opinions related to women's health. It is not intended as a statement of the standard of care. It does not explain all of the proper treatments or methods of care. It is not a substitute for the advice of a physician. Read ACOG’s complete disclaimer.