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Nature and severity of menopausal symptoms and their impact on quality of life and sexual function in cancer survivors compared with women without a cancer history

Marino, Jennifer L. MPH, PhD1,2; Saunders, Christobel M. MBBS Lond, FRCS, FRACS3,4; Emery, Laura I. BSci3; Green, Helena BSci, PostGrad-Sexology, CNS4; Doherty, Dorota A. PhD5; Hickey, Martha MBChB, MD, FRANZCOG1,2

doi: 10.1097/GME.0b013e3182976f46
Original Articles

Objective After cancer treatment, troublesome menopausal symptoms are common but poorly understood. Using standardized instruments, we measured differences in symptom nature, severity, impact on quality of life, and sexual function between cancer survivors and noncancer participants.

Methods The Menopause Symptoms After Cancer Clinic operates within the general menopause service in a large women’s hospital, providing menopause advice and management to women with menopausal symptoms and a cancer history. Menopausal symptoms were recorded using the Greene Climacteric Scale, past-week symptoms were recorded using the Functional Assessment of Cancer Therapy breast cancer subscale and endocrine symptom subscale, and sexual symptoms were recorded using Fallowfield’s Sexual Activity Questionnaire.

Results Cancer survivors (n = 934) and noncancer participants (n = 155) did not significantly differ by age at menopause (46 y) or age at first clinic visit (51 y). Cancer survivors were more likely than noncancer participants to be severely troubled by vasomotor symptoms (hot flushes and night sweats; odds ratio, 1.71; 95% CI, 1.06-2.74) and reported more frequent (6.0 vs 3.1 in 24 h; P < 0.001) and more severe (P = 0.008) hot flushes. In contrast, cancer survivors were significantly less troubled by psychological and somatic symptoms and reported better quality of life than noncancer participants. Groups did not differ significantly in physical or functional well-being, gynecologic symptom severity, or sexual function.

Conclusions Cancer survivors are more troubled by vasomotor symptoms than noncancer participants, but noncancer participants report greater psychological symptoms. Sexual function does not differ. An improved understanding of the nature and impact of menopause on cancer survivors can be used to direct management protocols.

Supplemental Digital Content is available in the text.

From the 1Department of Obstetrics and Gynecology, The University of Melbourne, Parkville, Victoria, Australia; 2Department of Obstetrics and Gynecology, Royal Women’s Hospital, Parkville, Victoria, Australia; 3School of Surgery, The University of Western Australia, Crawley, Western Australia, Australia; 4Menopause Symptoms After Cancer Clinic, King Edward Memorial Hospital, Subiaco, Western Australia, Australia; and 5School of Women’s and Infants’ Health, The University of Western Australia, Crawley, Western Australia, Australia.

Received March 14, 2013; revised and accepted April 15, 2013.

AstraZeneca had no role in the running of the clinic or in the preparation of this article.

Funding/support: King Edward Memorial Hospital provided the facilities to house the Menopause Symptoms After Cancer (MSAC) Clinic and database, and AstraZeneca provided an educational grant to help establish the MSAC Clinic. The National Breast and Ovarian Cancer Center and the National Breast Cancer Foundation of Australia provided financial assistance for clinic projects, research, and data collection, including a National Breast Cancer Foundation of Australia Concept Award (to M.H. and C.M.S.).

Financial disclosure/conflicts of interest: None reported.

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 (

Address correspondence to: Jennifer L. Marino, MPH, PhD, Department of Obstetrics and Gynecology, The University of Melbourne, Royal Women’s Hospital, Level 7, 20 Flemington Road, Parkville, Victoria 3052, Australia. E-mail:

© 2014 by The North American Menopause Society.