Study finds too few women are told chemotherapy can cause early menopause – or given the drug that can lessen that risk
When Patsy Mullen was diagnosed with breast cancer, she had no idea that chemotherapy treatment could lead to early onset menopause.
It was Mullen’s oncologist who mentioned the possibility, and offered the then 47-year-old the drug Goserelin, which reduces the risk by up to 70% compared with women receiving chemotherapy alone.
But a new study has shown many women in Mullen’s position are missing out on that choice.
Older women closer to natural menopausal age – on average 51 years old – and women with children are less likely to be offered the drug. That is because doctors assume fertility is the only consideration in a desire to delay menopause, according to a study published in Internal Medicine Journal.
Led by Dr Felicity Martin, the study analysed the medical records of adult women under the age of 48 receiving chemotherapy at the Peter MacCallum Cancer Centre in Melbourne between August 2020 and December 2022.
Of the 66 eligible patients, they found that one in four did not have a documented discussion regarding Goserelin, and that particular group of women were more likely to be older and have more children.
Younger patients yet to have children and who were being referred to a fertility service were more likely to be prescribed Goserelin.
Martin said that results indicated fertility is “at the forefront” of doctors’ minds when considering patients and Goserelin. “The women who are older and perhaps that already had their children or who weren’t interested in fertility preservation were less likely to have the discussion or be prescribed it.” She said doctors are “forgetting, potentially, that it’s not just important for fertility”.
Early onset menopause can also carry increased risk of osteoporosis and cardiovascular disease, sexual dysfunction, and adverse effects on mood and wellbeing. Menopausal symptoms are often more severe in women with chemotherapy-induced premature ovarian insufficiency (POI) compared with those undergoing natural menopause, the researchers noted.
Women on Goserelin – which is available on the pharmaceutical benefits scheme – take a monthly injection. Researchers want doctors to increase discussions and use of Goserelin in all premenopausal women, regardless of their fertility interests.
The study results were filtered to only include patients who were prescribed an alkylating chemotherapy, commonly used to treat breast cancer, sarcoma, haematological and gynaecological malignancies, and which carries the highest risk of POI, Martin said.
Mullen said her oncologist’s intervention in 2023 had a hugely positive impact post-diagnosis.
“I’m so grateful that my oncologist didn’t overlook the suitability of Goserelin for me just because I was at an age where having children wasn’t on my agenda,” she said.
Mullen said she chose to take the drug to potentially preserve her pre-menopausal years. “I don’t want to go into menopause at 47 and lose all those years I equate to being in a younger person’s body.”
Chemotherapy, immunotherapy, radiotherapy and surgery left her reeling, she said.
“My view was really that my body’s going through a hard enough time with the treatment itself … if I can avoid adding early menopause into the mix then that’s something that I was keen to consider and look at.”
Discussions about preventing early onset menopause should be on all oncologists’ radars when thinking about cancer survivorship, she said.
“Touch wood, I’ll be living in this body for many decades to come, and those good hormones playing that protective role for me for as long as possible really matters. It matters as much as being kept alive in the weeks and months after diagnosis.”
The researchers acknowledged the study’s limitations, including its small sample size and the fact that the results only came from the one specialised cancer centre.
Associate Prof Nicholas Wilcken, a Sydney-based oncologist on the board of Breast Cancer Trials ANZ, called it a “very sound” study that “highlights a very important point: if premature menopause can be avoided it should be”.
Wilcken said results were likely to be even worse in other centres. The Peter MacCallum Centre has been at the forefront of the issue, leading the original trial that showed the drug worked, he said.
Dr Belinda Kiely, a breast medical oncologist, said Goserelin is often thought about in terms of preserving fertility but “the group we often overlook are women we can prevent early onset menopause”.
