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Chemotherapy May Cause Early Menopause

Younger women who were treated with the cancer therapy saw their menstrual cycles end within a year of diagnosis.
BY Katie Kosko
PUBLISHED November 23, 2018
MORE THAN HALF OF women under 50 who were treated with chemotherapy for lung cancer experienced early menopause, according to study findings published in Menopause, making these patients vulnerable to the unwanted effects: infertility, hot flashes, vaginal dryness and bone thinning.

“When recommending chemotherapy initiation to a premenopausal patient with lung cancer, physicians should discuss the risk of premature menopause and, for those who have not yet completed their desired childbearing, the options for fertility preservation,” said study author Kathryn J. Ruddy, M.D., an associate professor of oncology at Mayo Clinic in Rochester, Minnesota.

A team of Mayo Clinic researchers examined 182 premenopausal women with lung cancer — 85 received chemotherapy and three received targeted therapy. The remaining 94 did not receive chemotherapy.

The women were surveyed between 1999 and 2016, at diagnosis and then annually, regarding menstrual status. In the chemotherapy group, 64 percent reported that they were menopausal within a year of diagnosis compared with 15 percent of women in the non-chemotherapy group.

Among women who received targeted therapy, two were premenopausal when the final survey was completed, a median of three years after diagnosis.

The way chemotherapy works — by killing cancer cells — can also affect organs beyond the tumor site. “Chemotherapy damages the ovaries by causing cell death,” Ruddy said. Women who might want to become pregnant later should consider harvesting their eggs and freezing them before chemotherapy to optimize future fertility, she said.

Women who experience menopausal symptoms during or after chemotherapy should tell their oncology team, Ruddy added: “There are both hormonal and nonhormonal ways to combat the symptoms of menopause.

For example, for women with hot flashes, antidepressants such as Effexor XR (venlafaxine) can be helpful.

For those who develop menopause-related osteoporosis, a bisphosphonate or RANK ligand-inhibiting medication should be considered. For vaginal dryness, use of a vaginal moisturizer and vaginal lubricant is usually the first-line treatment.”

Since 1975, the rate of lung cancer diagnosis has fallen by 32 percent in men but has risen 94 percent in women, according to Mayo Clinic. The disease has now surpassed breast cancer as the leading cause of cancer death in American women. Although lung cancer is more common in older adults, women — including about 5,000 premenopausal women a year — receive diagnoses at a younger age compared with men, wrote the study authors.

Ruddy hopes to further examine these issues in a larger group of lung cancer survivors and in young women who have been treated for other cancers, such as head and neck.
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