Common long-term side effects of chemotherapy include early menopause and weight gain. Although mainly a short-term side effect, fatigue can affect some people for a long time. Rare side effects include heart problems and leukemia.
Early menopause
Some chemotherapy drugs can damage the ovaries and stop regular menstrual cycles (amenorrhea). In women under 40, this condition may be temporary and periods will start again. In women over 40, it is more often permanent, meaning that menopause begins earlier than expected [23]. Although women may resume having periods months or years after chemotherapy ends, those who do not have a menstrual period for one year after treatment are likely to have early menopause rather than short-term amenorrhea [23].
Going through early menopause can be very upsetting. As with natural menopause, you may have symptoms such as hot flashes and vaginal dryness. And, because the onset of menopause is abrupt, these symptoms may be more intense than with natural menopause.
Early menopause can also affect bone health. Menopause can cause a loss of bone density (osteopenia or osteoporosis). And, some women who go through menopause have muscle or joint aches.
Learn about methods to ease menopausal symptoms.
Early menopause and fertility
If you were hoping to have a child after treatment, early menopause can be especially disheartening. However, there are procedures that may allow you to have children after treatment. Speak to a fertility specialist before starting treatment to understand your options.
The most common procedure for preserving fertility involves storing embryos before chemotherapy begins. In this procedure, some of your eggs are collected and fertilized by sperm from a spouse, partner or donor.
Insurance coverage for fertility services varies widely from state to state, so it is important to check with your insurance provider to find out which procedures are covered.
At this time, there are no known treatments to protect the ovaries from the damaging effects of chemotherapy.
Learn more about fertility options for women undergoing chemotherapy.
Weight gain
Unfortunately, weight gain is a common side effect of chemotherapy, especially in women who go into early menopause [23-24]. Changes in metabolism caused by chemotherapy and a less active lifestyle add to weight gain during treatment. One study found that women who got chemotherapy were 65 percent more likely to gain weight compared to those who did not [24].
Women who gain weight usually put on about five to ten pounds [23]. The more weight a woman gains, the less likely she is to return to her pre-diagnosis weight [24].
Making healthy food choices and getting regular exercise during treatment (if possible) may help prevent weight gain. Seeing a dietician may also help.
Heart problems and leukemia
Heart problems and leukemia are severe but rare side effects of chemotherapy. Leukemia has been linked to the use of cyclophosphamide, doxorubicin and epirubicin.
Heart problems, like cardiomyopathy (enlarged, weakened heart) and congestive heart failure, have been linked to the use of doxorubicin and epirubicin, and to use of trastuzumab. (Learn more about trastuzumab.) These conditions can sometimes be reversed if the drugs are stopped at the first sign of heart damage. Before you begin chemotherapy, your heart function will be measured to make sure that there are no pre-existing heart problems.
The risks of heart problems and leukemia are related to the dose of chemotherapy drugs. With the lower doses being given today, the risk of having either heart problems or leukemia is very low (about one percent) [23]. For most people with breast cancer, the benefits of chemotherapy far outweigh these risks.
Cognitive function/chemo-brain
Some people have cognitive problems after chemotherapy, including mental “fogginess” and trouble with concentration, memory and multi-tasking. This condition is often called “chemo-brain”. Most people have mild symptoms, though some have more troubling cognitive problems that impact daily life. Chemo-brain may last for one to two years after treatment or longer. Most people report that the symptoms go away over time.
The link between cognitive problems and breast cancer diagnosis and treatment remains unclear. Medicines used to treat side effects of chemotherapy, such as sleeping aids and anti-nausea medicines, can also cause these symptoms. And, stress, anxiety and depression can affect cognitive function. Symptoms may first appear with the stress related to diagnosis and treatment and then become worse after chemotherapy. At this time, the true extent of the cognitive effects of chemotherapy is not well understood. More research is needed in this area.
Updated 07/22/11
