Menstrual Disturbances Not Being Tracked, Treated in Cancer Patients 

New research suggests that some cancer patients do not have their menstrual history documented and do not receive treatment for menstrual disturbances. 

About 84% of patients studied did not have a menstrual history documented at their initial consult for a cancer diagnosis, and about 26% never had their menstrual history documented. 

Though 82% of patients reported menstrual disturbances — such as menopause and iron deficiency — most did not receive treatment for these conditions. 

These findings were published in the Journal of the National Comprehensive Cancer Network. 

For this study, researchers reviewed the medical charts of 137 women, aged 18 to 49 years, who were receiving anticancer treatment at a metropolitan hospital in Australia from 2017 to 2020. 

Cancer types included breast (54.0%), hematologic (20.4%), gastrointestinal (13.1%), head and neck (4.4%), lung (2.9%), central nervous system (2.2%), and gynecologic (0.7%) cancers as well as melanoma (2.2%).

The researchers found that 16.1% of patients had their menstrual history taken at the first consultation with their medical oncologist or hematologist. Some patients had their menstrual history documented at a later stage, either by their hematologist/oncologist (49.6%) or another health care professional (8.8%). The remaining 25.5% of patients had no recorded information about menstruation.

Of the 102 patients who did have their menstrual history documented, 82.4% reported a menstrual disturbance, most commonly amenorrhea (48.0%). Other disturbances included menopause or menopausal symptoms (20.6%), irregular menstrual bleeding (16.7%), menorrhagia (13.7%) dysmenorrhea (3.9%), and iron deficiency as a result of bleeding (2.9%). 

Counseling on menstrual disturbance was given to 18.2% of patients. Treatments were given to 38.1% of patients with menopause or menopausal symptoms, 33.3% of those with iron deficiency, 25.0% of those with dysmenorrhea, 21.4% of those with menorrhagia, 17.6% of those with oligomenorrhea, and 8.2% of those with treatment-induced amenorrhea.  

“Menstrual health is a fundamental aspect of health and has been promoted as a vital sign,” the researchers noted. “It is important for clinicians to understand the menstrual patterns of their patients at baseline, differentiate between normal and abnormal menstruation, and evaluate and treat the oncology/hematology patient’s menstrual changes.”

The researchers acknowledged that a lack of documentation does not necessarily mean that menstrual histories were not taken, but “the lack of documentation itself is a clinical quality metric that has clinical implications for people who menstruate.”

“Many cancer physicians and patients with cancer avoid discussions about menstruation due to feelings of discomfort or awkwardness, or because patients’ prognosis may be poor,” the researchers wrote. “Higher engagement could be achieved by better educating medical students and doctors on the relevant questions patients should be asked and the importance of timely menstrual history-taking.”

Reference

Chadwick V, Kim M, Mills G, et al. Rates of menstrual history-taking and counseling with anticancer treatments are low: People who menstruate deserve gender-specific cancer care. J Natl Cancer Inst. 2023;21(4):366-372. doi:10.6004/jnccn.2022.7255