Chemotheraphy-induced ovarian failure in women with breast cancer

Chemotherapeutic agents used for treatment of breast cancer often cause ovarian failure in premenopausal women. Clinical experience has shown that women have symptoms of menopause, although the nature of the symptoms have not been documented in the literature. Using an exploratory prospective design, the purpose of this study was to describe menopausal symptoms and their pattern of development in premenopausal women receiving adjuvant chemotherapy for breast cancer. Roger's Science of Unitary Human Beings served as the conceptual framework.

Fifty-two premenopausal women completed a demographic data form and the Menopause Symptom Assessment (MSA) questionnaire at three points: pre-chemotherapy, at the time of the third course and at the time of the fifth course of chemotherapy in the outpatient treatment area of a comprehensive cancer center. Average age was 42 years, and the majority of subjects were Caucasian, married, and well-educated. Forty-eight percent of the women had amenorrhea by the time of the fifth course.

Data were analyzed using Friedman two-way ANOVA to compare individual symptoms, and univariate analysis of variance to compare composite MSA scores across time. Significant increases in both frequency and severity were found for hot flashes, dizziness, vaginal dryness, weakness, and change in bowel habits (constipation). The frequency of depression and severity of anxiety decreased significantly over time. For the total MSA scores, there was a significant increase in symptom frequency when comparing pre-chemotherapy scores with scores at the time of the fifth course of treatment.

Results of this study indicate that women with breast cancer receiving chemotherapy experience menopausal symptoms, such as hot flashes and vaginal dryness. Other symptoms experienced by the women included dizziness, weight gain, weakness, fatigue and change in bowel habits, which increased in frequency and often in severity over time. Although all the symptoms may not be attributed to ovarian failure, they may cause distress for women being treated for breast cancer. Findings from this study are useful in the education of women undergoing chemotherapy, and serve as a basis for further research using longer follow-up periods and/or qualitative methodologies.