Abnormal periods may not be the first thing that comes to mind when thinking about leukemia symptoms. But the reality is that some women with leukemia experience changes in their menstrual cycle (period). For about 1 percent of women, abnormally heavy menstrual bleeding may be the first symptom that brought them to their doctor before a diagnosis of leukemia was made. A woman may also develop menopausal symptoms or enter early menopause while being treated for leukemia.
Here, we will explore the different effects leukemia can have on menstruation, including why they happen and how they may be managed.
Leukemia is a form of blood cancer that affects blood-forming tissues, including the bone marrow. Normally, the bone marrow produces blood cells, which then grow and divide as needed. But in people with leukemia, the bone marrow produces too many abnormal white cells that don’t work as intended. Leukemia causes symptoms when abnormal white blood cells begin to crowd out normal cells.
Among these symptoms are period abnormalities, which may be due to leukemia itself or to the treatments.
Thrombocytopenia refers to a low platelet count. In people with leukemia, thrombocytopenia can develop when abnormal blood cells displace platelets — the cells responsible for helping the blood clot. Having low levels of platelets — or having platelets that don’t work as they should to help with clotting — can lead to heavy menstrual bleeding. This symptom is sometimes seen in people with acute lymphocytic leukemia (ALL), acute myeloid leukemia (AML), and other types of leukemia.
The abnormally long, heavy, or irregular menstrual bleeding that some women with leukemia experience is also referred to as abnormal uterine bleeding (AUB). Women with leukemia and AUB may have unexpected heavy bleeding in the middle of their monthly menstrual cycle. When their period does come as expected, they may have an unusually heavy flow that lasts longer than usual.
AUB in leukemia may occur alongside thrombocytopenia, as well as other blood-related conditions, including anemia (low red blood cell count), neutropenia (low neutrophil count), and leukocytosis (excess leukocyte count).
Treatments for leukemia can have different effects on a woman’s menstrual cycle. Chemotherapy, in particular, can lead to thrombocytopenia and abnormally heavy bleeding by decreasing the platelet count. Platelets are blood cells that help blood clot.
However, chemotherapy can also damage the ovaries, potentially leading to amenorrhea (the absence of menstrual periods during a woman’s reproductive years). This effect is rare when leukemia is treated with methotrexate, Bleo 15K (bleomycin), Cosmegen (dactinomycin), Tolak (fluorouracil), and Oncovin (vincristine), but treatment with Cytoxan (cyclophosphamide) may make amenorrhea more likely. Anthracycline antibiotics — chemotherapy drugs including Cerubidine (daunorubicin) and Idamycin (idarubicin) — may also cause ovarian damage.
Amenorrhea can lead to infertility, as well as menopausal symptoms, including vaginal dryness, hot flashes, night sweats, mood swings, and changes to the menstrual cycle.
If leukemia treatment is causing abnormal menstruation, your cycle will likely return to normal after the treatment has ended, although this is not always the case. Always talk to your health care team about the best way of managing menstrual changes and their effects during and after your leukemia treatment.
It is important to note that even if your period becomes irregular or abnormal during leukemia treatment, you may still be able to become pregnant. Talk to your doctor about what birth control methods you should use while undergoing chemotherapy or other treatments for leukemia.
Because certain cancer treatments are known to make the menstrual cycle heavier, many health care teams prescribe medications that will stop a woman’s period before she begins treatment. These medications can help prevent blood loss and abnormally heavy bleeding in the case of thrombocytopenia.
One hormone drug, goserelin, temporarily “turns off” the ovaries’ functioning, helping to protect them from damage during chemotherapy. It also stops periods.
Abnormally heavy periods can lead to low iron and anemia (low red blood cell count). Tell your oncologist or health care team as soon as you experience any symptoms of anemia, such as dizziness, weakness, lightheadedness, headaches, or fatigue. If you do have anemia, your doctor may recommend dietary changes or prescribe iron supplements.
When excessively heavy or long-lasting, vaginal bleeding in women with leukemia causes anemia, it may require blood transfusions.
Hormone replacement therapy (HRT) is sometimes used to help manage menopausal symptoms in women with cancer. This therapy involves taking medications containing the female hormone estrogen. Low estrogen levels are responsible for the symptoms of menopause, so supplementing depleted estrogen can help minimize uncomfortable symptoms.
Roughly a third of women undergoing chemotherapy experience temporary infertility (the inability to conceive). This side effect of chemotherapy typically resolves within six or 12 months of stopping treatment. However, older women or those taking higher doses of cancer drugs may be more likely to become permanently infertile after undergoing chemotherapy.
If you are concerned about your fertility being affected during leukemia treatment, talk to your health care team about potential ways of preserving your ability to conceive by preserving your eggs. They may also recommend considering other methods of reproducing, such as receiving donor eggs.
It can be emotionally difficult to learn that your fertility has been affected by cancer treatment. If you are struggling to cope with potential infertility, ask your health care team for a referral to a counselor or other mental health care professional.
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