Thanks to significant progress in the field of oncology, a woman receiving a cancer diagnosis today is more likely than ever before to be cured. “Especially when it comes to the types of diagnoses we often see in younger women such as lymphoma (both Hodgkin’s and non-Hodgkin’s) and breast cancer. We’ve made so much progress that the potential to cure these cancers is excellent,” says Maurice Cairoli, MD, Virtua hematologist and oncologist.

This progress comes with an obvious and incredibly uplifting upside: Today, most women with cancer will have a full, long life ahead of them. On the downside, however, the chemotherapy used to treat cancer can often have negative long-term effects on a woman’s body.

“The reality of cancer survivorship both highlights the progress we’ve made and stresses the importance of anticipating and treating the long-term issues,” says Dr. Cairoli. “Together with our younger patients, we’re looking at life beyond the cancer diagnosis.”

Dr. Cairoli explains that the long-term effects of chemotherapy of primary concern to women, especially younger women, involve the potential premature onset of menopause. Three of the more significant resulting issues include the following.  

Possible Infertility

“We know that of women younger than 40 at the time of diagnosis and treatment, only about 20 to 25% will enter a permanent menopause and, therefore, become infertile,” says Dr. Cairoli. “The trouble is, we don’t have any way of knowing who those 20 to 25% will be.” For a woman who is married with three children, or for a woman who doesn’t foresee wanting children, this may be a moot point. “But for a woman in her 20s, who maybe isn’t even in a long-term relationship yet, chemotherapy-induced ovarian failure is of real concern.”

Another field of medicine, however, offers one possible solution to this quandary. “With all of the advances that have been made by fertility specialists, we now have the ability to quickly and efficiently harvest eggs, and store them indefinitely, all without adding any significant delay to the patient’s oncology treatment,” says Dr. Cairoli. “Cost can be an issue, and all insurance carriers might not cover it. But it’s something that the doctors in our practice always try to proactively bring up with our younger patients.”

Bone Loss

With premature onset of menopause comes all of the customary symptoms of traditional menopause. “These can include temporary discomforts, like hot flashes, as well as more serious issues, like bone loss,” says Dr. Cairoli. “Women who undergo chemotherapy are at greater risk for developing osteoporosis, and along with that can come loss of stature, loss of function, fractures, and joint and pain problems.”

However, just as is true in the case of traditional menopause, women experiencing premature menopause can turn to a wide range of prescription medications, as well as exercise (“so important,” emphasizes Dr. Cairoli), to help stem bone loss. “We can easily test for bone loss with a DEXA scan, which is a very safe outpatient procedure, and we have a host of very good medications at our disposal that have the ability to delay or even reverse bone loss. These can be oral medications like Fosamax that you take once a week, or Boniva that you take once a month, or there are even certain medicines that can be given intravenously just once a year.”

Sexual Health Issues

“After chemotherapy, my female patients often complain of significant vaginal dryness and pain with intercourse, and that naturally has an impact on their sexual health and relationship,” says Dr. Cairoli. “It’s not at all uncommon for a wife or couple to bring this up during a follow-up visit.”

It's important to bring it up, as there are many potential solutions to this uncomfortable problem. “The dryness and irritation can be easily and safely reversed by a course of estrogen-based vaginal therapy,” continues Dr. Cairoli. “That seems to be the most effective way I’ve seen to deal with this type of chemotherapy-induced estrogen deficiency symptom.” Once the physical symptoms are treated, the woman has a renewed opportunity to experience her sexual relationship in a way that’s comfortable and pleasurable for her.