3 February 2025
New research suggests that one in four women who undergo certain cancer chemotherapy treatments could be missing out on important conversations with their oncologists about a treatment that could prevent early-onset menopause.
Published in the Internal Medicine Journal, a publication of the Royal Australasian College of Physicians, the retrospective, single-centre study looked at whether doctors talked to their patients about goserelin, a drug that can reduce the risk of chemotherapy-related early-onset menopause by up to 70%.
Dr Felicity Martin, lead author of the study, says every premenopausal woman undergoing alkylating chemotherapy treatment for cancer should be having conversations with their doctor about their fertility and premature ovarian insufficiency (POI), commonly known as early onset menopause, and treatments available.
“More than 70% of women undergoing a certain class of chemotherapy for their cancer could be affected by POI, so it’s incredibly important for them to understand the effects of POI and the treatment available.
“Early-onset menopause can not only lead to infertility, but also sexual dysfunction, increased risk of osteoporosis and cardiovascular disease, hot flashes, mood swings and other adverse psychological effects.
“Fertility preservation, such as egg and embryo freezing, has often been a key focus in cancer guidelines, but it’s not the only thing doctors and patients should focus on when it comes to their reproductive and sexual health and the consequences of chemotherapy-related early menopause.
“Our study found that while 76% – or 50 out of 66 patients – had a documented discussion regarding goserelin for POI prevention in their medical notes, 24% – or 16 of 66 – did not. A total of 80% of patients were prescribed goserelin for POI prevention, but 20% were not.
“Women who were younger or had fewer children were more likely to be referred to a fertility clinic and be prescribed goserelin, while women who were older or had more children were less likely to have discussed or be prescribed goserelin.
Our findings suggest there is a degree of prescribing bias based on the patient’s age and parental status.
“As physicians, it is our duty of care to ensure our patients have all available information about their condition, the treatment options and their associated side effects so that patients are able to make fully informed decisions. There is a responsibility for oncologists to be having these conversations with their patients.
“While goserelin is only indicated for prevention of POI caused by certain types of cancer treatments, the long-term impacts of cancer treatment including early-onset menopause needs to be considered for all premenopausal women, regardless of their age or intention of having a child.
“We’ve heard from women that concerns about early-onset menopause can influence cancer treatment decision-making, so we want women feel they can talk to their oncologists and health practitioners candidly about what that could look like for them.
“All premenopausal women should be having conversations about POI with their oncologists – and we encourage women no matter your fertility plans to feel empowered to discuss all aspects of reproductive health with your doctor,” says Dr Martin.