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Chemotherapy increases early menopause risk for women with lung cancer

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August 30, 2018

Among women with lung cancer, chemotherapy may elevate the likelihood of amenorrhea and early menopause, according to research published in Menopause.

“While young women comprise an important cohort of lung cancer survivors, their risk of premature amenorrhea has not been previously investigated,” Elizabeth J. Cathcart-Rake, MD, medical oncologist at Mayo Clinic in Rochester, Minn., and colleagues wrote. “Our results suggest that self-reported menopause occurs soon after a lung cancer diagnosis for more than half of all premenopausal women with lung cancer.”

Researchers used data from questionnaires sent to 2,735 women diagnosed with lung cancer between 1999 and 2016 as part of the Mayo Clinic Epidemiology and Genetics of Lung Cancer Research Program. Of those, 182 women (mean age, 43 years) identified as premenopausal at diagnosis, and 85 of them received chemotherapy. Researchers found that 64% of the premenopausal women who received chemotherapy reported the onset of menopause within a year after diagnosis (mean age at diagnosis, 47 years for those reaching menopause vs. 43 years for those remaining premenopausal). In contrast, of the 94 women who did not undergo chemotherapy, 15% reported that they were menopausal within 12 months of diagnosis (mean age at diagnosis, 45 years vs. 43 years for those remaining premenopausal). Of the three remaining women, who received targeted therapy with no chemotherapy, two reported premenopausal status at 3 years following cancer diagnosis.

An adjustment to the communication between physicians and premenopausal women is needed when discussing lung cancer treatment plans, according to the researchers

“Premenopausal lung cancer patients should be educated about the risk for chemotherapy-related amenorrhea and the aforementioned lung cancer-specific amenorrhea considerations before therapy initiation,” the researchers wrote. “If future fertility is desired, reproductive endocrinology should be consulted to discuss options for embryo and oocyte cryopreservation — the gold standard techniques for fertility preservation in this setting.”

Researchers noted the small sample size and the need to study the effects of different chemotherapy agents to develop a better understanding of the relationship between certain agents and the onset of amenorrhea and menopause, especially in comparison to research done in relation to other forms of cancer.  

“Although more definitive research is needed, premenopausal women who need chemotherapy for lung cancer appear to have a similar risk of amenorrhea, early menopause and loss of fertility as premenopausal women receiving chemotherapy for breast cancer and lymphoma,” JoAnn Pinkerton, MD, FACOG, NCMP, executive director of The North American Menopause Society and division director of Midlife Health, University of Virginia Health System, said in a press release. “I agree that premenopausal patients with lung cancer need to be educated about the risk for chemotherapy-related amenorrhea, menopause issues (hot flashes, vaginal dryness and bone loss), and the potential loss of fertility before chemotherapy is initiated.” – by Phil Neuffer

Disclosures: The study was funded by the Mayo Foundation. Cathcart-Rake and Pinkerton report no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

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