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Influence of Menopausal Status on the Symptom Experience of Women Before Breast Cancer Surgery

Mazor, Melissa, PhD(c), RN; Cataldo, Janine K., PhD, RN; Lee, Kathryn, PhD, RN; Dhruva, Anand, MD; Paul, Steven M., PhD; Smoot, Betty J., PT, DPTSc, MAS; Dunn, Laura B., MD; Levine, Jon D., PhD; Mastick, Judy, MN, RN; Conley, Yvette P., PhD; Miaskowski, Christine, PhD, RN

doi: 10.1097/NCC.0000000000000545

Background Breast cancer treatments can change women's hormonal milieu and alter their symptom experience. Little is known about associations between menopausal status and menopausal symptoms in women with breast cancer before surgery.

Objective The purpose of this study was to evaluate for differences in occurrence, severity, and distress of symptoms between premenopausal and postmenopausal women before breast cancer surgery.

Methods A total of 312 women with breast cancer completed the Menopausal Symptoms Scale, a self-report measure that evaluated the occurrence, severity, and distress of 46 common symptoms associated with menopause. Regression analyses were used to evaluate for between-group differences in these symptoms.

Results Of the 312 patients enrolled, 37.4% (n = 116) were premenopausal, and 62.6% (n = 196) were postmenopausal. In the multivariate analysis that adjusted for 7 covariates, premenopausal patients reported higher occurrence rates for urinary frequency (P = .006) and reported lower occurrence rates for joint pain/stiffness (P = .011), difficulty falling asleep (P = .025), and vaginal dryness (P = .002). A significant interaction was found between age and menopausal status for hot flashes (P = .002), wake during the night (P = .025), and headache (P = .040).

Conclusion Regardless of menopausal status, women reported high occurrence rates for several menopausal symptoms. Associations between some symptom occurrence rates and menopausal status depended on the patients' age.

Implications for Practice As part of a preoperative symptom assessment, clinicians need to consider a woman's menopausal status and salient demographic and clinical characteristics. The identification of women with a higher symptom burden will assist with more effective management.

Author Affiliations: Schools of Nursing (Mss Mazor and Mastick and Drs Cataldo, Lee, Paul, and Miaskowski) and Medicine (Drs Dhruva, Smoot, and Levine), University of California at San Francisco; School of Medicine, Stanford University, California (Dr Dunn); and School of Nursing, University of Pittsburgh, Pennsylvania (Dr Conley).

This study was funded by grants from the National Cancer Institute (NCI; CA107091 and CA118658). Dr Christine Miaskowski is an American Cancer Society Clinical Research Professor and is funded by a K05 award from the NCI (CA168960). This project is supported by NIH/NCRR UCSF-CTSI grant number UL1 RR024131. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH. M.M. was funded by the American Cancer Society and a T32 grant (NR007088) from the National Institute of Nursing Research.

The authors have no conflicts of interest to disclose.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (

Correspondence: Christine Miaskowski, PhD, RN, Department of Physiological Nursing, University of California, 2 Koret Way, N631Y, San Francisco, CA 94143-0610 (

Accepted for publication July 24, 2017.

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