Does Ovarian Cancer Chemotherapy Affect Premenstrual Depression?

Does chemotherapy for ovarian cancer affect premenstrual depression?

Hello Doctor, I underwent chemotherapy for ovarian cancer last year and had one ovary removed.
Before the chemotherapy, I also received two doses of Lupron (initially misdiagnosed as uterine fibroids).
Recently, my premenstrual depression has worsened, and the school counselor advised me to check whether the treatments I received in gynecology might affect my hormones.
However, my follow-up appointment is in six months, so I'm reaching out here for advice.
In the future, if I want to improve my premenstrual depression, should I consult a gynecologist or a psychiatrist? Thank you for taking the time to respond.

Niming, 20~29 year old female. Ask Date: 2021/10/09

Dr. Cao Guotao reply Obstetrics and Gynecology

Hello, depression can be caused by a deficiency in hormones; however, you should not supplement hormones.
If you still feel unwell, it is advisable to consult a psychiatrist.
Wishing you good health.

Reply Date: 2021/10/09

More Info

Ovarian cancer chemotherapy can significantly impact a woman's hormonal balance, which in turn may exacerbate symptoms of premenstrual depression (PMDD). The removal of an ovary, as in your case, can lead to a decrease in estrogen production, which is crucial for mood regulation. Estrogen has been shown to have a positive effect on serotonin levels in the brain, and a deficiency can lead to mood disturbances, including depression and anxiety.

Chemotherapy itself can also induce a range of side effects, including hormonal changes, fatigue, and emotional distress. The medications used in chemotherapy can affect the hypothalamic-pituitary-ovarian axis, leading to alterations in menstrual cycles and hormonal fluctuations. This disruption can worsen premenstrual symptoms, including mood swings and depressive episodes.

Given your history of ovarian cancer and the treatments you've undergone, it is essential to consider the hormonal implications of your condition. The use of medications like leuprolide (Lupron), which you mentioned receiving, can further suppress ovarian function and estrogen levels, potentially contributing to your increased feelings of depression prior to your menstrual cycle.

To address your concerns about premenstrual depression, it is advisable to consult with both a gynecologist and a mental health professional. A gynecologist can evaluate your hormonal levels and discuss potential treatments, such as hormone replacement therapy (HRT), although this may be complicated by your cancer history. On the other hand, a mental health professional can provide strategies to manage depression, including cognitive-behavioral therapy (CBT) or medication options like selective serotonin reuptake inhibitors (SSRIs), which have been shown to be effective for PMDD.

It is important to note that while SSRIs have been scrutinized for their potential effects on cancer treatment, current evidence does not support a significant risk of increased cancer recurrence or adverse effects on chemotherapy outcomes. However, it is always best to discuss any concerns with your healthcare provider, who can tailor a treatment plan that considers both your mental health and cancer history.

In summary, the hormonal changes resulting from ovarian cancer treatment can indeed affect your mood and exacerbate premenstrual depression. A multidisciplinary approach involving both gynecological and psychological support will be beneficial in managing your symptoms effectively. Regular follow-ups with your healthcare team will ensure that any changes in your condition are monitored and addressed promptly.

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