Ribociclib, fertility, menopause and sexual health

Ribociclib, sold as Kisqali, is a CDK4/6 inhibitor tablet taken with hormone therapy for hormone receptor positive, HER2-negative breast cancer. On its own, ribociclib is not known to bring on menopause. Most of the changes women notice in periods, hot flushes, vaginal dryness and sex drive come from the hormone treatment it is combined with. After menopause, that is usually an aromatase inhibitor, which lowers oestrogen even further. Before menopause, doctors also switch off the ovaries with a monthly or three-monthly injection such as goserelin, so periods stop and menopause-like symptoms appear. Ribociclib itself can harm an unborn baby, so pregnancy must be avoided during treatment and for at least three weeks after the last dose, and breastfeeding should also stop. Animal studies suggest ribociclib may affect sperm production in men, although the effect in people is not well known. If you might want children in future, the best time to talk about fertility is before any treatment begins, because options such as freezing eggs or embryos are easier to arrange at that point. Many sexual and menopause symptoms can be eased with simple, non-hormonal approaches, and it is always worth raising them with your team, even if it feels awkward. You are not expected to simply put up with them.

Periods stopping does not mean you cannot conceive

Even when periods stop, ovulation can occasionally happen, especially at the start of ovarian suppression. Reliable contraception is still needed.

Non-hormonal contraception

Hormonal pills, patches and hormone-releasing devices are generally avoided with hormone receptor positive breast cancer. A copper coil or condoms are usual choices.

Symptoms can be treated

Hot flushes, dryness and pain during sex often improve with practical help.

Research on fertility and CDK4/6 inhibitors is still limited, and it is fair to say so.

Few pregnancies have been studied

Because pregnancy is avoided on ribociclib, there is little information about pregnancies after treatment. What is known comes mostly from wider breast cancer research.

Age matters a lot

Chemotherapy before ribociclib, and your age, often affect fertility more than ribociclib does. Women closer to natural menopause may not have periods return.

Advanced disease changes the picture

In advanced breast cancer, treatment is usually long-term, and pregnancy decisions become much more complex. These are personal conversations to have with your team.

What this page cannot tell you

It cannot tell you your own chance of pregnancy after treatment. A fertility specialist, working with your oncologist, can advise.

Changes in desire, comfort and body image are common during breast cancer treatment. They affect many couples, and help is available.

Easing dryness

Use a non-hormonal vaginal moisturiser a few times a week, and a water-based or silicone lubricant during sex. Avoid perfumed soaps and douches.

Vaginal oestrogen

Low-dose vaginal oestrogen is sometimes considered for severe symptoms, but it is usually avoided with aromatase inhibitors. Only use it if your oncologist agrees.

Talking with your partner

Explaining that tiredness and low oestrogen, not a lack of love, are behind the changes can ease strain. Closeness does not have to mean intercourse.

Getting more support

A gynaecologist, counsellor or specialist nurse can help with pain, low desire or relationship worries.