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

• Authors: Melanie H. Jacobson, Emory University; Ann Mertens, Emory University; Jessica Spencer, Emory University; Amita Manatunga, Emory University; Penelope Howards, Emory University
• Journal Title: Fertility and Sterility
• Volume: Volume 105, Number 3
• Publisher: Elsevier | 2016-03-01, Pages 765-772
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1016/j.fertnstert.2015.11.020
• Subjects: Health Sciences, Epidemiology; Health Sciences, Oncology
• Keywords: Science & Technology; Life Sciences & Biomedicine; Obstetrics & Gynecology; Reproductive Biology; Amenorrhea; menstrual function; cancer treatment; cancer survivorship; EARLY BREAST-CANCER; CHEMOTHERAPY-RELATED AMENORRHEA; MENSTRUAL-CYCLE PATTERNS; DISEASE-FREE SURVIVAL; OVARIAN FAILURE; ADJUVANT CHEMOTHERAPY; REPRODUCTIVE FACTORS; PREMENOPAUSAL WOMEN; DIABETES-MELLITUS; PROGNOSTIC IMPACT

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.