{"id":18184,"date":"2023-09-08T13:50:23","date_gmt":"2023-09-08T18:50:23","guid":{"rendered":"https:\/\/naturalwomanhood.org\/?p=18184"},"modified":"2024-10-02T11:27:04","modified_gmt":"2024-10-02T16:27:04","slug":"estudio-las-alteraciones-menstruales-en-las-pacientes-de-cancer-a-menudo-no-se-tratan","status":"publish","type":"post","link":"https:\/\/naturalwomanhood.org\/es\/study-menstrual-disturbances-in-female-cancer-patients-often-go-unaddressed\/","title":{"rendered":"Estudio: Las alteraciones menstruales de las pacientes con c\u00e1ncer no suelen tratarse"},"content":{"rendered":"\n

At Natural Womanhood, we frequently reference the menstrual cycle\u2019s significance as a \u201cfifth vital sign<\/a>,\u201d especially\u2014 according to the American College of Obstetricians and Gynecologists (ACOG)<\/a>\u2014 for girls and young women<\/a>. Menstrual cycle disturbances, often caused by chemotherapy<\/a>, are common amongst female cancer patients. Troublingly, a new study<\/a> from Australia reports, these menstrual disturbances regularly go unaddressed or are inadequately addressed [1].<\/p>\n\n\n\n

Many female cancer patients experience menstrual disturbances<\/span><\/h2>\n\n\n\n

The study authors observed that chemotherapy (chemo), in particular, predisposes women to heavy bleeding, anovulatory bleeding (bleeding episodes but no ovulation) or secondary amenorrhea<\/a> (cessation of periods in a woman who previously cycled regularly or irregularly). Heavy bleeding in turn puts women at risk of iron deficiency, anemia, and low platelet counts requiring blood transfusion. Among women who lose their periods during chemo, cycles are likely to return but may be irregular, especially in women who are in their 30s or older at time of diagnosis, and\/or had never had children before their cancer diagnosis [2]. Furthermore, irregular cycles post-chemo often translate to difficulty getting pregnant [2]. Cancer treatment can also induce menopause. <\/p>\n\n\n\n

Despite all this, the study authors wrote, \u201cno guidelines currently exist on how clinicians should address menstruation changes in this context. Current guidelines on the management of people who menstruate requiring cancer therapies focus on fertility preservation rather than the assessment and management of menstrual disturbances\u201d [1].  <\/p>\n\n\n\n

Who was studied<\/span><\/h2>\n\n\n\n

The study included 137 premenopausal women aged 18-49 who were diagnosed with cancer between 2017 and 2020 at a large cancer center in Sydney, Australia. These women received<\/a> \u201cchemotherapy, hormonal therapy, immunotherapy, and\/or radiation.\u201d Most of the women (54%) were diagnosed with breast cancer, followed by blood or blood cell cancer (20.4%) and gastrointestinal cancer (13.1%). A minority of women had head and neck cancer (4.4%), lung cancer (2.9%), melanoma skin cancer (2.2%), central nervous system cancer (2.2%), or gynecologic cancer (0.7%). 92.7% of women were in their 30s (33.6%) or 40s (59.1%) at the time of their cancer diagnosis. 90.5% underwent chemotherapy and\/or surgery (73.7%). <\/p>\n\n\n\n

What was studied<\/span><\/h2>\n\n\n\n

The study measured:<\/p>\n\n\n\n

    \n
  1. How often menstruation history was documented by healthcare professionals, whether at the initial consultation with an oncology (cancer treatment) team, or at a later time<\/li>\n\n\n\n
  2. How often menstrual disturbances occurred <\/li>\n\n\n\n
  3. How often healthcare professionals provided education about and\/or treatment of menstrual disturbances<\/li>\n<\/ol>\n\n\n\n

    Menstruation history<\/span><\/h3>\n\n\n\n

    Only 16.1% of the women had a menstruation history documented at their first visit with their cancer team, whereas 58.4% of women had this information documented later on. The remainder, 25%, or 1 in 4 female cancer patients, never had documentation in their medical chart about menstruation. Women with a breast cancer diagnosis were most likely to have their menstruation history documented. <\/p>\n\n\n\n

    How often menstrual disturbances occurred in female cancer patients<\/span><\/h3>\n\n\n\n

    Of the nearly 75% of women who did have menstruation history documented at some point during their cancer treatment, 82.4% of them did experience a menstrual disturbance. The most common disturbance was treatment-induced amenorrhea (48.0%), and then \u201cmenopause or menopause symptoms (20.6%), irregular menstrual bleeding (16.7%), menorrhagia [heavy bleeding] (13.7%), dysmenorrhea [painful periods] (3.9%), and iron deficiency as a result of bleeding (2.9%).\u201d Multiple women experienced more than one kind of menstrual disturbance. <\/p>\n\n\n\n

    How often healthcare professionals addressed treatment-induced menstrual disturbances<\/span><\/h3>\n\n\n\n

    Despite the vast majority of female cancer patients experiencing some kind of menstrual disturbance over the course of their cancer treatment, just over 18% of study participants were ever counseled on the possibility of experiencing treatment-induced menstrual disturbances like loss of periods, irregular bleeding, or heavy bleeding, and only 7.8% were counseled before treatment(s) began. <\/p>\n\n\n\n

    Menopause symptoms, iron deficiency, and painful periods were the menstrual disturbances most likely to be addressed. However, only 38% of women experiencing menopause symptoms got help, only 33% of women with iron deficiency were treated, and just 25% of women with painful periods were treated. Amenorrhea caused by cancer treatments was addressed just 8% of the time. <\/p>\n\n\n\n

    Why don\u2019t cancer care providers address menstrual disturbances?<\/span><\/h2>\n\n\n\n

    The study authors opined, \u201cMany cancer physicians and patients with cancer avoid discussions about menstruation due to feelings of discomfort or awkwardness, or because patients\u2019 prognosis may be poor\u201d [1]. And yet, the researchers noted, healthcare professionals need to understand their patients\u2019 baseline menstrual patterns, distinguish between normal and abnormal menstruation, and diagnose and treat menstrual disturbances. \u201cDiscussing and documenting a patient\u2019s menstruation history early in cancer assessment is essential, given cancer treatment\u2019s implications on a patient\u2019s fertility, bleeding risk, and psychosocial well-being.\u201d <\/p>\n\n\n\n

    While these discussions certainly may be uncomfortable, they need to take place, particularly since, as the researchers noted, \u201cprior research has found that people with cancer wish they had been better prepared for potential reproductive issues by their cancer providers\u201d [1]. <\/p>\n\n\n\n

    Do the results of this study apply to everyone? <\/span><\/h2>\n\n\n\n

    The researchers acknowledged that the study was retrospective, meaning it evaluated events that occurred in the past\u2013and, of course, human memory isn\u2019t always perfectly accurate. To avoid this issue, future research should also include prospective studies, meaning studies that follow patients over time. Additionally, future research should include whole hospital systems and other geographic regions, since this study focused on care provided to female cancer patients at one large cancer center in Australia. <\/p>\n\n\n\n

    What needs to change? <\/span><\/h2>\n\n\n\n

    What should be done to ensure that menstruation history is documented and then addressed during cancer treatment? On a practical level, there\u2019s a saying in healthcare that \u201cIf it wasn\u2019t documented, it didn\u2019t happen.\u201d Any healthcare professional knows that documentation is most likely to occur if it is automated, meaning that it pops up or is flagged as required in an electronic charting system. A simple first step would be to add a menstrual history tool into electronic charting templates for female cancer patients. <\/p>\n\n\n\n

    The study authors also encouraged education of medical students and doctors \u201don the relevant questions patients should be asked and the importance of timely menstrual history-taking\u201d [1]. Certainly, more education amongst healthcare professionals<\/a> is necessary, especially about the basics of the natural female cycle<\/a> and the health benefits of ovulation<\/a>, aka why the menstrual cycle is the \u201cfifth vital sign<\/a>.\u201d <\/p>\n\n\n\n

    But the most important piece in all this may be educating and empowering individual women to know what\u2019s normal and what\u2019s not<\/a> for their own cycles. This enables them to become effective self-advocates<\/a>, whether with their OB\/GYN or a cancer doctor. At Natural Womanhood, we strive to ensure every woman knows that through fertility awareness methods she can learn to read her own biological data, and to use that data in whatever way she needs, be it for family planning or health monitoring. Inadequate or absent attention to treatment-induced menstrual disturbances in female cancer patients may be the status quo, but it needn\u2019t remain that way. <\/p>\n\n\n\n

    References:<\/p>\n\n\n\n[1] Chadwick, V., Kim, M., Mills, G., Tang, C., Anazodo, A., Dear, R., Rodgers, R., Lavee, O., Milliken, S., McCaughan, G., Moore, J., Withers, B., & Hamad, N. (2023). Rates of Menstrual History-Taking and Counseling With Anticancer Treatments Are Low: People Who Menstruate Deserve Gender-Specific Cancer Care, Journal of the National Comprehensive Cancer Network<\/em>, 21<\/em>(4), 366-372. Retrieved May 3, 2023, from https:\/\/jnccn.org\/view\/journals\/jnccn\/21\/4\/article-p366.xml<\/a><\/p>\n\n\n\n[2] Jacobson MH, Mertens AC, Spencer JB, Manatunga AK, Howards PP. Menses resumption after cancer treatment-induced amenorrhea occurs early or not at all. Fertil Steril. 2016 Mar;105(3):765-772.e4. doi: 10.1016\/j.fertnstert.2015.11.020. Epub 2015 Dec 1. PMID: 26658130; PMCID: PMC4779728.<\/p>\n\n\n\n

    Additional Reading:<\/p>\n\n\n\n

    Ovarian tissue freezing: A better way to potentially preserve fertility in women facing cancer treatment<\/a><\/p>\n\n\n\n

    Can you monitor your fertility with fertility awareness methods during chemotherapy, and will it return after chemo? <\/a><\/p>\n\n\n\n

    Lisa Hendrickson-Jack explains how natural menstrual cycles provide the \u201cfifth vital sign\u201d<\/a><\/p>\n\n\n\n

    \u201cThe menstrual cycle is a vital sign of your health:\u201d A women\u2019s health NP explains why every pre-teen girl needs to learn about her cycle<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"Qu\u00e9 hace la quimioterapia en tu ciclo y por qu\u00e9 es importante","protected":false},"author":85,"featured_media":18188,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_kad_blocks_custom_css":"","_kad_blocks_head_custom_js":"","_kad_blocks_body_custom_js":"","_kad_blocks_footer_custom_js":"","csco_singular_sidebar":"","csco_page_header_type":"","csco_page_load_nextpost":"","csco_post_video_location":[],"csco_post_video_url":"","csco_post_video_bg_start_time":0,"csco_post_video_bg_end_time":0,"footnotes":""},"categories":[5362,5181],"tags":[5413,4104,5929,6344],"class_list":{"0":"post-18184","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-cycle-dysfunctions","8":"category-reproductive-and-menstrual-disorders","9":"tag-cancer","10":"tag-fertility-awareness-methods","11":"tag-health-benefits-of-charting","12":"tag-menstrual-disturbances-in-cancer-patients","13":"cs-entry","14":"cs-video-wrap"},"acf":[],"yoast_head":"\nMenstrual disturbance in cancer patients is commonly unaddressed - 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