Chemotherapy may cause acute amenorrhea leading to early menopause in women with lung cancer, a US study has shown.

In findings that may guide advice on embryo and oocyte cryopreservation for young women before cancer treatment, researchers at the Mayo Clinic, Minnesota, found that about half of young women who started chemotherapy for lung cancer became menopausal within a year of diagnosis.

The study was based on a cohort of 182 premenopausal women with average age at lung cancer diagnosis of 43 years. Among the 85 patients who received chemotherapy – all platinum-based treatments and most including taxane –  46% self-reported that they had become menopausal within a year of diagnosis.

In contrast, only 15% of the 94 women who did not receive systemic therapy within one year of diagnosis experienced self-reported menopause.

Three patients received targeted therapy alone, two of whom remained premenopausal at the final qualifying survey, completed a median of three years after diagnosis.

When followed up longer term, only 12 of 54 women who became menopausal after chemotherapy reported transient return to fertility.

Writing in Menopause, the study authors said premature menopause was already known to occur in 40-80% of young women receiving breast cancer chemotherapy but theirs was one of the first studies to explore the risk in young women with lung cancer.

And since lung cancer diagnosis was increasing for younger women, the new finding had implications for counselling on fertility measures before starting treatment

“Premenopausal lung cancer patients should be educated about the risk for chemotherapy-related amenorrhea and the aforementioned lung cancer-specific amenorrhea consider-ations before therapy initiation,” the authors suggested.

“If future fertility is desired, reproductive endocrinology should be consulted to discuss options for embryo and oocyte cryopreservation – the gold standard techniques for fertility preservation in this setting,” they added

“Although more definitive research is needed, premenopausal women who need chemotherapy for lung cancer appear to have a similar risk of amenorrhea, early menopause, and loss of fertility as premenopausal women receiving chemotherapy for breast cancer and lymphoma,” commented Dr JoAnn Pinkerton, executive director of North American Menopause Society.

“I agree that premenopausal patients with lung cancer need to be educated about the risk for chemotherapy-related amenorrhea, menopause issues (hot flashes, vaginal dryness, and bone loss), and the potential loss of fertility before chemotherapy is initiated.”