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Amenorrhea after lung cancer treatment

Cathcart-Rake, Elizabeth J., MD1; Ruddy, Kathryn J., MD, MPH1; Gupta, Ruchi2; Kremers, Walter, PhD2; Gast, Kelly, MD3; Su, H. Irene, MD, MSCE4; Partridge, Ann H., MD, MPH5; Stewart, Elizabeth A., MD6; Liu, Han, MD7,8; He, Yanqi, MD, PhD7,9; Yang, Ping, MD, PhD7

doi: 10.1097/GME.0000000000001199
Original Articles

Objective: More than 5,000 premenopausal women are diagnosed with lung cancer annually in the United States. Limited data exist regarding the risk of treatment-related amenorrhea, a surrogate for infertility and early menopause, after systemic therapies for lung cancer.

Methods: Premenopausal women diagnosed with lung cancer under age 50 were surveyed at diagnosis and annually thereafter about their menstrual status as a part of the Mayo Clinic Epidemiology and Genetics of Lung Cancer Research Program. Types of lung cancer-directed treatments were recorded, and frequencies of self-reported menopause at each survey were calculated.

Results: A cohort of 182 premenopausal women were included in this study, with average age at lung cancer diagnosis 43 years (SD 6). Among the 85 patients who received chemotherapy, 64% self-reported that they had become menopausal within a year of diagnosis. Platinum salts were universally included in these chemotherapy regimens, and the majority of these women also received taxanes within 1 year of diagnosis. Only 15% of the 94 patients who did not receive systemic therapy within 1 year of diagnosis experienced self-reported menopause. Three patients received targeted therapy alone, two of whom remained premenopausal at the final qualifying survey, completed a median of 3 years after diagnosis.

Conclusions: Chemotherapy for lung cancer patients appears to increase risk of early loss of menses in survivors.

1Department of Oncology, Mayo Clinic, 200 First St SW, Rochester, MN

2Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN

3Department of Internal Medicine, Mayo Clinic, Rochester, MN

4Department of Obstetrics, Gynecology and Reproductive Science, University of California, San Diego, La Jolla, CA

5Department of Oncology, Dana-Farber Cancer Institute, Boston, MA

6Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN

7Department of Epidemiology, Mayo Clinic, Scottsdale, AZ

8Department of Respiratory Medicine, The First Hospital of Jilin University, Changchun, China

9Department of Respiratory Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China.

Address correspondence to: Elizabeth J. Cathcart-Rake, MD, Department of Oncology, Mayo Clinic, 200 First St SW, Rochester, MN 55905. E-mail:

Received 19 May, 2018

Revised 6 July, 2018

Accepted 6 July, 2018

Funding/support: This work was supported by Mayo Foundation funds, and by the National Institutes of Health [grant numbers R01CA80127, R01CA84354, R01CA115857, and KL2 TR002379].

Financial disclosure/conflicts of interest: Dr Cathcart-Rake, Dr Ruddy, Ms Gupta, Dr Gast, Dr Su, Dr Partridge, Dr Liu, Dr He, and Dr Yang have nothing to disclose. Dr Stewart reports personal fees from Gynesonics, Redwood City, CA; Bayer, Leverkusen, Germany; GlaxoSmithKline, London, UK; Astellas Pharma, Tokyo, Japan; Welltwigs, Minneapolis, MN; and AbbVie, North Chicago, IL, all outside the submitted work. Dr Kremers reports funding from AstraZeneca, Cambridge, UK; Roche, Basel, Switzerland; and Biogen, Cambridge, MA, outside the submitted work.

© 2019 by The North American Menopause Society.