In the JournalsPerspective

Menopausal symptoms more troublesome for cancer survivors

Recent data suggest that the severity of menopausal symptoms tends to be worse in women who survive cancer compared with other women. However, psychological and social quality of life measures were better among cancer survivors, researchers wrote.

“The reason for this difference in emotional well-being is not known but may be attributable to the better social and psychological support associated with a cancer diagnosis compared with that of menopause,” Jennifer L. Marino, MPH, PhD, of the department of obstetrics and gynecology at the University of Melbourne in Australia, and colleagues wrote.

Jennifer L. Marino, MD, PhD 

Jennifer L. Marino

The researchers measured differences in symptoms, severity, impact on quality of life and sexual function between cancer survivors and non-cancer patients at The Menopause Symptoms After Cancer Clinic.

The researchers recorded cancer survivors’ (n=934) and non-cancer patients’ (n=155) menopausal symptoms using the Greene Climacteric Scale; past-week symptoms using the Functional Assessment of Cancer Therapy breast cancer subscale and endocrine symptom

Subscale; and sexual symptoms using Fallowfield’s Sexual Activity Questionnaire.

The majority of patients were previously diagnosed with breast cancer (82%), while a smaller proportion was diagnosed with gynecological cancer (10.5%), or hematologic and colorectal malignancies (7.5%).

According to data, cancer survivors were more likely to be severely affected by vasomotor symptoms such as hot flushes and night sweats (OR=1.71; 95% CI, 1.06-2.74) and reported more frequent (6 vs. 3.1 in 24 hours; P<.001) and more severe (P=.008) hot flushes, compared with non-cancer patients.

Margery Gass, MD 

Margery Gass

“Seventy-nine percent of cancer survivors and 61% of non-cancer participants reported current severe vasomotor symptoms. Thirty-six percent of cancer survivors and 23% of non-cancer participants scored in excess of the upper bound of the published reference range for vasomotor symptoms,” researchers wrote.

Conversely, cancer survivors demonstrated less psychological and somatic symptoms compared with non-cancer patients (P<.001). Further, they reported better quality of life. However, there were no statistically significant variations in physical or functional well-being, gynecologic symptom severity or sexual function, researchers wrote.

“Both expected and surprising, these results highlight that all menopausal women, including cancer survivors, need effective treatment options for their hot flashes and sexual symptoms,” Margery Gass, MD, executive director of the North American Menopause Society, said in a press release.

Disclosure: The researchers report no relevant financial disclosures.


JoAnn E. Manson

  • A burgeoning number of women worldwide are both cancer survivors and entering menopause. It is clearly a clinical challenge to treat menopausal symptoms in women with a history of cancer because many are not candidates for estrogen therapy. The study by Marino and colleagues indicates that cancer survivors may have a higher prevalence and severity of vasomotor symptoms than women without a history of cancer. The findings highlight the importance of evaluating cancer survivors for the presence of menopausal symptoms, assessing their needs for treatment and discussing available treatment options. Additional research in this field and an expanded arsenal of nonhormonal treatment options for menopausal symptoms will be essential to improve the clinical care of this growing patient population. In this regard, the recent approval by the FDA of a nonhormonal treatment for vasomotor symptoms is a step in the right direction.

    • JoAnn E. Manson, MD, DrPH, NCMP
    • Past-president of the North American Menopause Society
      Endocrinologist and professor of medicine, Harvard Medical School and Brigham and Women’s Hospital
      Chief of Preventive Medicine, Brigham and Women’s Hospital
  • Disclosures: Manson reports no relevant financial disclosures.