When Lisa Ray revealed that chemotherapy pushed her into early menopause at just 37, she also highlighted a reality many young cancer survivors quietly face.
Diagnosed with multiple myeloma in 2009, the actor has spoken about feeling unprepared for the sudden loss of fertility and the emotional toll that followed.
Doctors say her experience reflects an important gap in cancer care. While treatment focuses on survival, the long-term effects on ovarian function and hormonal balance are often not discussed enough.
Experts now stress that chemotherapy can damage ovarian cells, reduce egg reserves, and in some cases trigger temporary or permanent menopause, making early counselling and fertility planning crucial.
According to Dr Mandeep Singh Malhotra, Director – Surgical Oncology at the CK Birla Hospital, Delhi, chemotherapy works by targeting rapidly dividing cancer cells but can also affect other fast-growing cells in the body, including those in the reproductive system.
“As a result, chemotherapy may damage ovarian function and lead to temporary or permanent menopause in some patients,” he explains.
Dr Sudha Sinha, Clinical Director & HOD, Senior Consultant, Medical Oncology & Hemato-Oncology at Yashoda Hospitals, Hyderabad, adds that the risk is higher in women above 35–40 years, those undergoing longer treatment durations, or those receiving certain chemotherapy drugs such as alkylating agents.
CAN EARLY MENOPAUSE BE PREVENTED?
Doctors say there are protective options, but they must be discussed before treatment begins.
“Before starting chemotherapy, we discuss fertility preservation strategies,” says Dr Sinha. These include egg or embryo freezing, ovarian tissue freezing, and medications like GnRH analogues that temporarily suppress ovarian function during treatment.
In cases where pelvic radiation is planned, ovarian transposition may also be considered.
Dr Malhotra explains that GnRH agonists temporarily suppress ovarian activity, which may reduce chemotherapy-related damage. “When the ovaries are inactive, their cells divide less, potentially lowering the risk of harm,” he says.
However, he cautions that no method offers a guarantee, and early planning significantly improves outcomes.
WHY ISN’T THIS DISCUSSED MORE OPENLY?
Despite being a known side effect, chemotherapy-induced early menopause often takes a backseat in discussions.
“At diagnosis, survival and cancer control are the immediate priorities. Patients and families are overwhelmed,” says Dr Sinha. Fertility and long-term hormonal health may feel secondary at that stage.
Social discomfort around discussing reproductive health and the assumption that periods will return after treatment also contribute to the underestimation of the risk.
Experts say cancer care has evolved. With better survival rates, attention is increasingly shifting toward survivorship and quality of life, including fertility preservation and prevention of what is often called “chemopause.”
IS HORMONE REPLACEMENT THERAPY SAFE?
Hormone replacement therapy (HRT) can help manage severe menopausal symptoms and protect bone and cardiovascular health. But it is not suitable for everyone.
Dr Sinha notes that the safety of HRT depends on the type of cancer and individual risk factors. In hormone-sensitive cancers, such as hormone receptor–positive breast cancer, HRT is generally avoided due to concerns about recurrence.
In survivors without hormone-driven cancers, it may be considered if symptoms are significant and there are no major contraindications.
Dr Malhotra adds that the decision should always be individualised after careful discussion with the oncology team.
Ray’s candid disclosure has brought attention to a crucial aspect of cancer treatment, that survival is only one part of the journey. For many women, informed discussions before chemotherapy can make a meaningful difference in protecting fertility, managing symptoms, and planning life after cancer.
