Chemo-Induced Menopause Symptoms Similar to Spontaneous

Kate Johnson

October 21, 2013

DALLAS — Breast cancer patients who have chemotherapy-induced menopause have climacteric symptoms at rates similar to those of women who go through spontaneous menopause before their breast cancer diagnosis, a new study shows.

"We were quite surprised when we looked at the results. I was certainly expecting to find that younger women who had chemotherapy-induced ovarian failure would have more severe symptoms," said Martha Hickey, MD, from the University of Melbourne in Australia.

"A lot of assumptions are made, but they've never actually been tested. Because the women were younger, and because they had been through chemo, which stopped their periods, we expected patients with chemotherapy-induced menopause to have worse symptoms. In fact, they didn't," she said.

"It's good news for cancer patients," she told Medscape Medical News here at the North American Menopause Society 2013 Annual Meeting, where she presented the findings.

The study involved breast cancer survivors who were referred because of severe symptoms to the Menopause Symptoms After Cancer Clinic at Royal Women's Hospital in Parkville, Australia.

It's good news for cancer patients.

One group of 232 women had been menstruating normally before their diagnosis of breast cancer, at a mean age of 44 years. They experienced chemotherapy-induced menopause at a mean age of 45 years.

Another group of 294 women experienced spontaneous menopause at a mean age of 49 years, and were diagnosed with breast cancer at a mean age of 56 years.

All women made their first visit to the clinic within 3 years of their breast cancer diagnosis.

Investigators measured menopause symptoms with the Greene Climacteric Scale (GCS) and its subscales. They evaluated quality of life with the Functional Assessment of Cancer Therapy (FACT) scale, which includes subscales for endocrine symptoms, breast cancer, physical wellbeing, social, family, and functional wellbeing. They assessed sexual function with Fallowfield's Sexual Activity Questionnaire and subscales of the GCS and FACT.

"The women who had chemo-induced ovarian failure were more likely to have had antiestrogen endocrine therapy (78% vs 67%; P = .003) and to be on endocrine therapy when they came to the clinic (57% vs 41%; < .001)," reported Dr. Hickey. "Not surprisingly, the younger women were much less likely to have taken hormone replacement therapy (7% vs 72%; < .001)."

There were no differences in the 2 groups in the proportion of women who had hot flushes (about 80%), severe flushes (about 65%), night sweats (about 70%), or more than 10 hot flushes per day (about 30%).

Similarly, there were no differences between chemotherapy-induced and spontaneous menopause in mean scores on the GCS domains of anxiety (5.97 vs 5.72), depression (5.83 vs 5.22), psychological symptoms (10.72 vs 11.85), or somatic symptoms (5.04 vs 5.22).

"One thing we did note was a worse cancer-specific quality-of-life score on the breast cancer subscale with chemotherapy-induced menopause (22.14 vs 24.78; P = .01). However, the other symptoms on the FACT scale were the same," she said.

On the Fallowfield's Sexual Activity Questionnaire — which measures current sexual activity, reasons for sexual inactivity, and pleasure, discomfort, and habit — "the 2 groups were largely the same," Dr. Hickey said. "Most of the women were in a relationship, few had changed partners, and many were not sexually active (36% in the chemotherapy-induced group and 47% in the spontaneous group). There were no differences in sexual pleasure, discomfort, or habit."

On the GCS and FACT sexual domains, "women who went through chemotherapy-induced ovarian failure complained of more pain with sexual intercourse (30% vs 25%; P = .04), but other sexual symptoms, such as loss of interest and vaginal dryness, were not significantly different. It's really quite common for these women to have vaginal dryness secondary to their ovarian failure and, potentially, to endocrine therapy," she said.

"These are interesting data, which at first glance appear to conflict with the conventional wisdom that abrupt menopause is harder from a symptoms standpoint," said Ann Partridge, MD, from the Dana-Farber Cancer Institute in Boston.

However, it is important to remember that both sets of study subjects included "women who had presented to a symptom clinic," she noted. "Women in both groups were experiencing enough symptoms to seek help."

"What this study seems to show is that among women with symptoms, they are not worse with chemotherapy-induced versus natural menopause," she pointed out. "However, the study did not include the large proportion of women with natural menopause who don't experience symptoms, or the likely much smaller group of women who experience abrupt menopause and have no symptoms."

According to Dr. Partridge, it is likely that the proportion of women who experience severe menopausal symptoms is smaller with natural than with chemotherapy-induced menopause. "The study is not telling us what proportion of all women in this setting — regardless of group — have bad symptoms, but that when they have symptoms, they are equally burdensome."

Dr. Hickey reports receiving a Cancer Australia Research Grant, a National Breast Cancer Foundation Concept award, and an AstraZeneca Educational Grant, which was used to establish the Menopause Symptoms After Cancer Clinic. Dr. Partridge has disclosed no relevant financial relationships.

North American Menopause Society (NAMS) 2013 Annual Meeting: Abstract S-10. Presented October 10, 2013.


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