Relationship of menopausal symptoms and ovarian reserve in reproductive-aged cancer survivors
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Relationship of menopausal symptoms and ovarian reserve in reproductive-aged cancer survivors Anat Chemerinski 1
&
Katherine Cameron 2 & Mary Sammel 3 & Jill Ginsberg 4 & Claire Carlson 4 & Clarisa Gracia 2
Received: 23 October 2019 / Accepted: 27 January 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose This study sought to evaluate the prevalence of menopausal symptoms in a population of reproductive-aged women remote from cancer therapy compared with a group of healthy similar-aged controls and with a cohort of late reproductive-aged (LR) controls. Methods Participants were assessed for symptoms of menopause, early follicular phase hormones, and ultrasound examinations. Menopausal symptoms were analyzed in exposed participants and controls using χ2 analyses, Wilcoxon-Mann Whitney tests, and multivariable logistic regression models. Results One hundred seventy cancer survivors, 135 similar-aged controls, and 71 LR controls were followed prospectively for an average of 38 months. Compared with similar-aged controls, a greater proportion of survivors reported vasomotor symptoms at some point over the study period (35% vs 19%, p < 0.01), and this proportion was similar to LR controls (44%, p = 0.22). Survivors were more likely to be bothered by vaginal dryness (27%) than similar-aged controls (16%, p = 0.02) or LR controls (14%, p = 0.02). FSH levels were 38.4% higher in those with vasomotor symptoms compared with those without symptoms (p = 0.021). Conclusions Reproductive-aged cancer survivors have a higher prevalence of vasomotor symptoms and vaginal dryness than their similar-aged peers. Implications for Cancer Survivors Providers should be attuned to the high prevalence of menopausal symptoms in cancer survivors. Keywords Menopause . Vasomotor symptoms . Vaginal dryness . Anti-Mullerian hormone . Antral follicle count
Introduction Survivors of childhood cancers, many of whom are premenopausal girls and adolescents, face short-term side effects and long-term sequelae of cancer treatments. Of particular concern to this population is the risk of developing menopausal symptoms as a result of cancer treatment [1, 2]. While menopause is
* Anat Chemerinski [email protected] 1
Obstetrics and Gynecology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
2
Reproductive Endocrinology and Infertility, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
3
Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
4
Oncology, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
defined as the absence of menses for 1 year, many survivors may experience menopausal symptoms for decades following cancer therapy without meeting the definition of menopause [3]. Large retrospective cohort studies evaluating cancer survivors have demonstrated serious impacts on fertility from cancer treatments, including acute ovarian failure [4] and premature men
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