Chadwick Verity, Kim Michaela, Mills Georgia, Tang Catherine, Anazodo Antoinette, Dear Rachel, Rodgers Rachael, Lavee Orly, Milliken Samuel, McCaughan Georgia, Moore John, Withers Barbara, Hamad Nada
Royal North Shore Hospital, St. Leonards, NSW, Australia.
University of New South Wales, Kensington, NSW, Australia.
J Natl Compr Canc Netw. 2023 Apr;21(4):366-372. doi: 10.6004/jnccn.2022.7255.
Chemotherapy predisposes people who menstruate to abnormal uterine bleeding that can be life-threatening and may also damage ovaries, resulting in premature menopause. The purpose of this study was to explore the incidence of menstrual history documentation and counseling before, during, and after cancer treatment.
The medical charts of 137 consecutive females (self-reported) aged 18 to 49 years receiving anticancer treatment at a major tertiary metropolitan hospital in Australia between 2017 and 2020 were reviewed. Data collected included primary diagnosis, stage of cancer, treatment(s) received, rates of remission or progression, documentation of involvement of a specialist gynecologist, reproductive history, menstrual disturbances, menstruation counseling or intervention offered, and diagnosis of early ovarian failure.
Only 16.1% of patients had their menstrual history documented at the initial consult, and 49.6% had their menstrual history documented at a subsequent consult with their treating oncologist or hematologist. Most (82.4%) patients with a menstrual history documented experienced menstrual disturbance posttreatment, most commonly amenorrhea (48.0%), followed by menopause or menopause symptoms (20.6%), irregular menstrual bleeding (16.7%), menorrhagia (13.7%), dysmenorrhea (3.9%), and iron deficiency from bleeding (2.9%). Menopause/Menopausal symptoms and iron deficiency were more likely to be treated than other disturbances.
Menstruation disturbance is a common side effect of cancer treatment. Menstrual care should be integral to cancer care for people who menstruate, and higher engagement could be achieved through education of medical and allied health staff, information technology systems automating prompts and referral pathways, regular audits to ensure compliance, better alliances between cancer and fertility specialists, and the creation of accessible patient information to promote awareness and facilitate discussion.
化疗会使月经来潮的人易发生危及生命的异常子宫出血，还可能损害卵巢，导致过早绝经。本研究的目的是探讨癌症治疗前、治疗期间和治疗后月经史记录及咨询的发生率。
回顾了2017年至2020年期间在澳大利亚一家大型三级城市医院接受抗癌治疗的137名连续的18至49岁女性（自我报告）的病历。收集的数据包括初步诊断、癌症分期、接受的治疗、缓解或进展率、专科妇科医生参与的记录、生殖史、月经紊乱、提供的月经咨询或干预以及早期卵巢功能衰竭的诊断。
仅16.1%的患者在初次咨询时记录了月经史，49.6%的患者在随后与主治肿瘤学家或血液学家的咨询中记录了月经史。大多数（82.4%）记录了月经史的患者在治疗后出现月经紊乱，最常见的是闭经（48.0%），其次是绝经或绝经症状（20.6%）、月经不规则出血（16.7%）、月经过多（13.7%）、痛经（3.9%）和出血性缺铁（2.9%）。绝经/绝经症状和缺铁比其他紊乱更有可能得到治疗。
月经紊乱是癌症治疗的常见副作用。月经护理应成为月经来潮者癌症护理的组成部分，通过对医疗和相关卫生人员的教育、自动化提示和转诊途径的信息技术系统、定期审计以确保合规、癌症和生育专家之间更好的联盟以及创建易于获取的患者信息以提高认识并促进讨论，可以实现更高的参与度。
