“Menopause is often a frequently neglected area,” declared Mindy E. Goldman, MD, Clinical Professor, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco (UCSF), and a member of the Breast Oncology Program, UCSF Helen Diller Family Comprehensive Cancer Center. Yet menopausal complaints are common and often more severe in cancer survivors than in the general population. Dr. Goldman is a member of the NCCN Survivorship Panel, serving as subcommittee Chair on menopause-related symptoms and subcommittee Co-Chair on sexual function.
Although the clinical definition of menopause is 1 year without menses, it often does not apply to cancer survivors who have had prior chemotherapy or hormonal therapies to treat breast cancer. “In those situations, you may need to rely on menopausal levels of estradiol and follicle-stimulating hormone [FSH],” Dr. Goldman suggested. In addition, she added, recent data also suggest that antimüllerian hormone may be a relevant hormonal marker of ovarian reserve.1
Dr. Goldman briefly reviewed some of the common symptoms of menopause. “By far, hot flashes are the most common menopausal complaint, occurring in approximately 80% of women,” she noted. Moreover, sleep problems may exist beyond the effect of hot flashes. “It has been shown that women don't get into a deep REM [rapid eye movement] sleep often after menopause,” she said.
Dr. Goldman offered several possible reasons why menopausal symptoms are often more severe in cancer survivors: surgical treatments may include oophorectomy with immediate onset of surgical menopause; premenopausal women with normal menstrual functioning may have ovarian shutdown with chemotherapy; postmenopausal women taking hormone replacement therapy tend to abruptly stop when diagnosed with endocrine-dependent cancers; and vasomotor symptoms are common with hormonal drugs such as tamoxifen or aromatase inhibitors.
For Dr. Goldman, the key is to be sure that menopausal complaints are included in the assessment of cancer survivors. “You won't know if your patients are having these problems if you don't remember to ask,” she stressed.
Fréour T, Barrière P, Masson D. Anti-müllerian hormone levels and evolution in women of reproductive age with breast cancer treated with chemotherapy. Eur J Cancer 2017;74:1–8.
Zhou Q, Yin W, Du Y. Prognostic impact of chemotherapy-induced amenorrhea on premenopausal breast cancer: a meta-analysis of the literature. Menopause 2015:22:1091–1097.
Ruddy KJ, Gelber SI, Tamimi RM. Prospective study of fertility concerns and preservation strategies in young women with breast cancer. J Clin Oncol 2014;32:1151–1156.
Moore HC, Unger JM, Phillips KA. Goserelin for ovarian protection during breast-cancer adjuvant chemotherapy. N Engl J Med 2015;372:923–932.
Perino A, Calligaro A, Forlani F. Vulvo-vaginal atrophy: a new treatment modality using thermo-ablative fractional CO2 laser. Maturitas 2015;80:296–301.