Menses resumption after cancer treatment-induced amenorrhea occurs early or not at all

• Type of Material: Article
• Authors: Melanie H. Jacobson, Emory University; Ann Mertens, Emory University; Jessica Spencer, Emory University; Amita Manatunga, Emory University; Penelope Howards, Emory University
• Language: English
• Date: 2016-03-01
• Publisher: Elsevier
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2016 American Society for Reproductive Medicine.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.fertnstert.2015.11.020
• Title of Journal or Parent Work: Fertility and Sterility
• ISSN: 0015-0282
• Volume: 105
• Issue: 3
• Start Page: 765
• End Page: 772
• Grant/Funding Information: Funding for this research was provided by The Eunice Kennedy Shriver National Institute of Child Health and Human Development Grant 1R01HD066059.
• Keywords: cancer treatment; CHEMOTHERAPY-RELATED AMENORRHEA; ADJUVANT CHEMOTHERAPY; Reproductive Biology; REPRODUCTIVE FACTORS; Amenorrhea; Life Sciences & Biomedicine; EARLY BREAST-CANCER; PROGNOSTIC IMPACT; Science & Technology; PREMENOPAUSAL WOMEN; cancer survivorship; MENSTRUAL-CYCLE PATTERNS; menstrual function; OVARIAN FAILURE; DIABETES-MELLITUS; Obstetrics & Gynecology; DISEASE-FREE SURVIVAL
• Research Categories: Health Sciences, Epidemiology; Health Sciences, Oncology

Abstract

Objective To identify factors associated with cancer treatment-induced amenorrhea and time to return of menses. Design Population-based cohort study Setting Georgia Patients Female cancer survivors who were diagnosed with cancer between the ages of 20–35 and were at least 2 years post-diagnosis at the time of recruitment (median=7 years, interquartile range= 5–11). Intervention(s) None Main Outcome Measure(s) Amenorrhea (≥ 6 months without menses) and resumption of menses. Results After excluding women with hysterectomies prior to cancer diagnosis, 1,043 women were eligible for analysis. Amenorrhea occurred in 31.6% of women. Among women treated with chemotherapy (n=596), older age at diagnosis (30–35 versus 20–24 years: adjusted odds ratio (aOR)=2.37, 95% confidence interval (CI): 1.30, 4.30) and nulligravidity (versus gravid: aOR=1.50, 95% CI: 1.02, 2.21) were risk factors for amenorrhea. Among amenorrheic women, menses resumed in most (70.0%), and resumption occurred within 2 years of treatment for 90.0% of women. Survivors of breast cancer were more likely resume menses at times greater than one year compared with lymphoma and pelvic-area cancers. Women diagnosed at older ages, those exposed to chemotherapy, and those exposed to any radiation experienced longer times to return of menses. Women who were older at diagnosis were more likely to have irregular cycles when menses returned. Conclusion Treatment-induced amenorrhea is common in cancer survivors although most women resume menses within 2 years. However, once resumed, older women are more likely to have irregular cycles. Age at diagnosis and pregnancy history affect the risk of amenorrhea.