A French study recently published in ScienceDaily suggests that women who have suffered from childhood cancer may run a greater risk of developing premature menopause.
Researchers from Inserm, a French public hospital organization (AP-HP), the Institut Gustave Roussy, and the Universite Paris-Sud studied the menopausal age of 706 women who had experienced childhood cancer.
Woman who had undergone treatment with alkylating agents, radiation to the ovaries, or those who had undergone a unilateral oophorectomy experienced menopause four to seven years earlier than the average woman.
Data was analyzed on 1,522 childhood cancer survivors diagnosed between 1945 and 1986 when they were under 18 years of age. Out of the 1,522 survivors, 706 completed a detailed questionnaire about their current state of health. Thirty-two percent of these women had reached the age of 40, and 7 percent were over the age of 50.
The research team looked at their menopausal age by the questionnaire information received and potential associated risk factors such as those treated with radiotherapy. It is important to note that the menopausal assessments were based on the self-reported questionnaires and not by laboratory FSH levels.
The data revealed that approximately 13 percent of women were menopausal at the age of 44, which is considered seven years earlier than the average; menopause was surgically induced for a third of these women.
The main focus of this study was to identify the potential risk factors contributing to early onset menopause in these women, and it appeared that being treated during puberty was associated with non-surgical menopause. In addition, the maximum risk of early menopause was noted in women who had received alkylating agents alone or in combination with radiotherapy to the ovaries after the onset of puberty. As mentioned earlier, unilateral oophorectomy is also a contributing factor and may cause a woman to reach a menopausal state much sooner than the average.
Twenty-one percent of the cohort experienced menopause before the age of 40, and the key risk factors associated with premature menopause were:
- Women being treated during young adulthood
- The dose of alkylating agents used with drugs such as cyclophosphamide or Melaphan received during bone marrow transplantation
- Radiation dose received in the ovarian area
The discussion of fertility is very important in the AYA population, and the early onset of menopause should also be a part of that discussion for young females who are of reproductive age. Women who had received cancer treatment as teens or even into their twenties should be advised not to delay their first pregnancy into their mid to late thirties, because they run the risk of developing early menopause.
Have you treated any patients that have experienced early onset menopause due to childhood cancer treatment? Does your oncology team discuss the potential risk of early menopause with the AYA population?