title: Menses resumption after cancer treatment-induced amenorrhea occurs early or not at all.
abstract: OBJECTIVE
  To identify factors associated with cancer treatment-induced amenorrhea and time to return of menses.
  
  
  METHODS
  Population-based cohort study.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  Female cancer survivors who were diagnosed with cancer between the ages of 20 and 35 and were at least 2 years postdiagnosis at the time of recruitment (median = 7 years; interquartile range, 5-11).
  
  
  METHODS
  None.
  
  
  METHODS
  Amenorrhea (≥6 months without menses) and resumption of menses.
  
  
  RESULTS
  After excluding women with hysterectomies before cancer diagnosis, 1,043 women were eligible for analysis. Amenorrhea occurred in 31.6% of women. Among women treated with chemotherapy (n = 596), older age at diagnosis (30-35 vs. 20-24 years: adjusted odds ratio [aOR] = 2.37; 95% confidence interval [CI], 1.30, 4.30) and nulligravidity (vs. gravid: aOR = 1.50; 95% CI, 1.02, 2.21) were risk factors for amenorrhea. Among amenorrheic women, menses resumed in most (70.0%), and resumption occurred within 2 years of treatment for 90.0% of women. Survivors of breast cancer were more likely to resume menses at times greater than 1 year compared with lymphoma and pelvic-area cancers. Women diagnosed at older ages, those exposed to chemotherapy, and those exposed to any radiation experienced longer times to return of menses. Women who were older at diagnosis were more likely to have irregular cycles when menses returned.
  
  
  CONCLUSIONS
  Treatment-induced amenorrhea is common in cancer survivors, although most women resume menses within 2 years. However, once resumed, older women are more likely to have irregular cycles. Age at diagnosis and pregnancy history affect the risk of amenorrhea.
authors.affiliation: Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia. Electronic address: mhymanjacobson@emory.edu.
authors.forename: Melanie H
authors.initials: MH
authors.lastname: Jacobson
authors.affiliation: Department of Pediatrics, Aflac Cancer and Blood Disorders Center, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Ann C
authors.initials: AC
authors.lastname: Mertens
authors.affiliation: Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Jessica B
authors.initials: JB
authors.lastname: Spencer
authors.affiliation: Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia.
authors.forename: Amita K
authors.initials: AK
authors.lastname: Manatunga
authors.affiliation: Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia.
authors.forename: Penelope P
authors.initials: PP
authors.lastname: Howards
mesh_terms: D000328:Adult; D000367:Age Factors; D000568:Amenorrhea / Q000139:chemically induced* / Q000175:diagnosis / Q000503:physiopathology; D000970:Antineoplastic Agents / Q000009:adverse effects*; D005260:Female; D005845:Georgia; D006801:Humans; D016015:Logistic Models; D008597:Menstrual Cycle / Q000187:drug effects* / Q000528:radiation effects*; D009369:Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D016017:Odds Ratio; D010298:Parity; D011247:Pregnancy; D016016:Proportional Hazards Models; D011832:Radiation Injuries / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D011878:Radiotherapy / Q000009:adverse effects; D012042:Registries; D012307:Risk Factors; D017741:Survivors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents
keywords: Amenorrhea; cancer survivorship; cancer treatment; menstrual function