Carrying on: the experience of premature menopause in women with early stage breast cancer

BACKGROUND: The survival benefit of adjuvant chemotherapy for breast cancer is established but the experience of organ system toxicity for women, specifically ovarian toxicity, is not fully known. OBJECTIVES: Th e purpose of the study was to develop asubstantive theory that would describe and explain women's responses to chemotherapy-induced premature menopause within the context of breast cancer. METHODS: Qualitative inquiry with Grounded Theory methodology was used to collect, code, and analyze the data. The purposive sample consisted of 27 women with early stage breast cancer who received adjuvant chemotherapy. The majority of women were married, well educated, and employed with a mean age of 41 years. Amenorrhea was reported by 24 women, a peri-menopausal pattern of bleeding was described by two women, and one woman had return of normal menses. Women participated in interviews ranging from 45 minutes to 2 hours and other data sources, such as informal discussions with oncology care providers, and lay women's writings about menopause and midlife women's health were used to increase interpretation of the data. RESULTS: Vulnerability was identified as the basic social psychological problem for women. Carrying On is the basic process that explains how women respond to vulnerability as they attempt to assimilate drug-induced premature menopause into their breast cancer experience. The stages of Carrying On (Being Focused, Facing Uncertainty, Becoming Menopausal, and Balancing) progressed from minimizing the early menopause experience to developing an awareness to balancing the dynamic relationship of menopause and cancer in their lives. CONCLUSIONS: This study described the complexity of the experience of chemotherapy-induced premature menopause in women with early stage breast cancer and identified gaps in knowledge about menopausal symptom distress and factors influencing symptom management and outcomes in this population. Future research is needed to evaluate interventions during and after adjuvant therapy to improve the quality of survival of women who experience ovarian toxicity related to early stage breast cancer treatment.     

Menopausal symptom experience: an online forum study

Title.  Menopausal symptom experience: an online forum study
Aim.  The aim of the study was to explore the menopausal symptom experience of White midlife women.
Background.  Recent cross-cultural investigations have indicated important ethnic differences in menopausal symptoms and have challenged the universality of these symptoms. Currently available cultural knowledge on menopausal experience, however, is inadequate to guide appropriate and adequate care even for White women in the menopausal transition.
Method.  A cross-sectional qualitative online forum study was conducted in 2007 with 23 midlife women who self-identified as non-Hispanic Whites using convenience sampling. Seven topics related to menopausal symptom experience were used to guide the online forum for 6 months. The data were analysed using thematic analysis.
Results.  The experiences of menopause caused women to redefine themselves within their busy daily life schedules. They were optimistic about their symptoms, and tried to laugh at the experience to boost their inner strength and motivate themselves to persevere. Many thought that both generational and life-style differences were much more important than ethnic differences in menopausal symptom experiences. In seeking assistance with the symptoms of menopause, women were not satisfied with the guidance of their physicians.
Conclusion.  Nurses need to listen carefully to what women themselves say about their own experiences with menopausal symptoms and avoid imposing predetermined symptom management strategies. Further studies of women's perceptions of life-style influences are needed to guide symptom management. In addition, studies of generational changes in menopausal symptom experience are needed.     

Acute menopause symptoms during adjuvant systemic treatment for breast cancer: a case-control study

The purpose of this study was to ascertain whether acute menopause symptoms experienced by women with breast cancer differed from those of women experiencing a natural menopause. For the study, 200 women younger than 65 years of age receiving adjuvant systemic treatment for breast cancer were invited to complete a self-report questionnaire incorporating a previously validated tool: the Greene Climacteric Scale. The control group consisted of 200 women 50 to 64 years of age who did not have a breast cancer diagnosis. An overall response rate of 59.5% was obtained. The majority of the respondents were peri- or postmenopause at the time of the study, reporting either "irregular periods" or "no periods." Findings demonstrated that women receiving adjuvant systemic breast cancer treatment were more likely than the control group to report a current experience of menopause symptoms. Women with breast cancer also reported a higher incidence and severity of specific menopause symptoms (tiredness, hot flushes, night sweats) than control subjects. These differences remained statistically significant when controls were used for potential confounding variables such as age, menopause status, and time since last period. Hot flushes ranked second only to tiredness as side effects attributed to cancer treatments. Because of the intimate and supportive nature of their role, nurses are in a key position to conduct future research relating to women's experiences of menopause symptoms and potential therapeutic interventions. Within the specific context of breast cancer care, oncology nurses are recognized as having a central role in informing and supporting women throughout the breast cancer trajectory. Thus they are ideally placed to address menopause as a particular survivorship issue.     

Measurement of symptom distress in women with early-stage breast cancer

While symptom distress can alter the cancer experience, it is difficult to define and measure. This study's aims were (1) to determine whether the McCorkle Symptom Distress Scale (SDS) or the Rhodes Adapted Symptom Distress Scale (ASDS) was the more accurate measure of symptom distress in women with breast cancer; (2) correlate both scales with a visual analogue scale (VAS) measuring anxiety, a symptom frequently reported clinically; (3) determine tool preference; and (4) establish when during the first cycle of chemotherapy the highest levels of symptom distress were experienced. One hundred twenty women were recruited and measurement of symptom distress (SDS and ASDS) and anxiety (VAS) taken at the start of chemotherapy (Time 1), at the nadir (Time 2), and at the end of the cycle (Time 3). Both instruments were highly correlated and detected change over time; none was correlated with the VAS anxiety scale. Symptom distress scores were generally low, with fatigue, appearance, insomnia, and concentration causing the greatest distress. Other factors like functioning, body image, and menopausal symptoms cited as contributors to symptom distress levels were not measured and could account for low scores and perhaps suggest that symptom distress may not be accurately measured in today's women with early-stage breast cancer.     

中年女性围绝经期症状及影响因素的研究现状分析

围绝经期由于激素水平下降出现潮热、心悸、失眠、记忆力下降、性欲减退、烦躁、抑郁、阴道干涩及泌尿系统疾病等身体和心理的不适症状。不同种族、不同地域和个人经历的女性,在围绝经期的症状存在差异,不同程度地影响其健康。本文作者通过文献分析,探讨女性围绝经期症状及影响因素的研究趋向。发现围绝经期症状直接影响女性的身心健康状况、生活质量水平,我国大多数围绝经期女性的自我保护意识尚低。因此,明确围绝经期女性的症状特点和影响因素,有助于提供适宜有效的健康干预。     

Women's perceptions and beliefs about the use of complementary and alternative medicines during menopause

INTRODUCTION: Studies of menopausal women are providing increasing evidence of the reasons for complementary and alternative medications (CAM) use during menopause, the types of CAM used and the prevalence of use; however, further insight into the experiences of women using CAM during menopause is required. The aim of this study was to put CAM use during menopause into context by identifying and describing the factors that influence menopausal women in their decision to use CAM. METHODS: Menopausal women participated in focus groups and telephone interviews and the following information were collected: symptoms experienced during menopause; therapies (other than hormones) used to cope with menopause, and the perceived benefits of these therapies, and how the women found out about these therapies. The data collected were analysed using thematic analysis. RESULTS: Fifteen women participated in the study; 13 in the focus groups and two in telephone interviews. The women reported using a diverse range of therapies, supplements and activities. Empowerment was a central theme throughout the study. The level of support from the women's general practitioners was reported to be a major influence in their decision to take CAM. The availability of information about CAM and individual determinants, such as symptoms and perceptions of menopause, were also identified as significant influences. CONCLUSION: The women in this study expressed a desire to have control over their symptoms and the way in which their menopause was treated. This study has highlighted a need for more information and education about menopause and, in particular, the range, safety and efficacy of CAM use during menopause. The study also shows there is a need for strong participatory relationships between women and their health professionals.     

Coping with recurrent breast cancer: predictors of distressing symptoms and health-related quality of life

Little is known about how postmenopausal women with recurrent breast cancer cope with distressing symptoms and which factors predict health-related quality of life (HRQOL). In the present study, 56 consecutively enrolled patients completed questionnaires measuring symptom occurrence, coping capacity, coping efforts, and HRQOL at the time of recurrence. Results from this study illustrate that women with recurrent breast cancer suffer from multiple, concurrent, and interrelated symptoms of illness, anxiety, depression, and fatigue. Highly prevalent symptoms are lack of energy, difficulty sleeping, pain, worrying, problems with sexual interest, feeling sad, and dry mouth. The most frequently occurring symptom is problem with sexual interest, and the most severe symptom is worrying. The most distressing symptom experienced is pain. The majority of the women report 10-23 symptoms. Women who experience multiple symptoms also report higher levels of symptom distress. The experience of distressing symptoms is predicted by coping capacity, and the coping efforts experienced predict HRQOL. Patients with lower coping capacity report higher prevalence of symptoms, experience higher levels of distress, and experience worse perceived health, which in turn may decrease their HRQOL. To help women manage recurrent breast cancer, it is important to use multidimensional measurement to identify, evaluate, and treat distressing symptoms, and not assess single symptoms only. Care must be based upon the awareness of critical factors that exacerbate vulnerability to distress, as well as the ability to adapt to a recurrent breast cancer disease.     

Cross-cultural menopausal experience: comparison of Australian and Taiwanese women

A more universal approach to the understanding of menopause can offer health professionals a broader view of the phenomenon. The present study's objectives were to describe and explain the menopausal experiences of Asian and Occidental women, and to examine the relationship between social/cultural factors and women's menopausal symptoms. Questionnaires were used to investigate psychosocial and cultural factors and menopausal symptoms in 45-55 years old Taiwanese (n = 105) and Australian (n = 450) women. The variables investigated included: social demography; menopause status; attitudes toward menopause; mental health; vitality; social functioning; and menopausal symptoms. Significant differences were found between Taiwanese and Australian women in their attitude towards menopause, menopausal symptoms and vitality scores. No significant differences were seen in the areas of social functioning, mental health and menopause status. The results suggest that cultural factors may influence the experience of menopause for women. These findings may improve health professionals' understanding of cultural beliefs relating to menopause so that culturally appropriate care can be provided.     

Anxiety in Menopause: A Distinctly Different Syndrome?

Anxiety is a common mood symptom that may be experienced by some menopausal women; however, few studies have explored the concept of anxiety in the context of menopause. Consequently, the anxiety experience in menopause is not well defined and raises the question: Is menopausal anxiety a unique and distinctly different syndrome? The aim of this qualitative study was to gain an in-depth understanding of the experience of new-onset anxiety in menopausal women.     

Women's needs and wants when seeing the GP in relation to menopausal issues

OBJECTIVE: To explore women's needs and wants when seeing the GP in relation to menopausal issues. DESIGN: A qualitative interview study. SETTING AND SUBJECTS: The study was part of a larger project, targeting menopause. It included in-depth interviews of 24 women aged 52-53 years who came from all over Denmark. The women showed a great variety of menopausal experience of symptoms and treatment. MAIN OUTCOME MEASURES: An acquaintance with the women's agendas when seeing the GP about menopausal issues. RESULTS AND CONCLUSION: Women consulting their GPs either wanted to discuss treatment for menopausal symptoms, to have an examination for diseases or to get a risk assessment. Their needs for medication or examination were satisfied but several women wanted more information, especially about the pros and cons of hormone therapy (HT). Risk assessment, if not requested, indicated problems, with some women feeling uncomfortable if the GPs started a discussion about HT and osteoporosis, if they only wanted an examination to be reassured that everything was normal. The authors' findings indicate that GPs encounter a subtle balance in considering the question of risk information to menopausal women who do not request it.     

Alternatives to hormone replacement therapy: a multi-method study of women's experiences

OBJECTIVE: To explore women's decision-making regarding use of complementary and alternative medicines (CAM) during menopause. METHODS: Qualitative interviews were conducted with 20 women who were currently or had previously used hormone replacement therapy (HRT), including questions about their experiences with alternatives to HRT. This was followed by a non-random questionnaire survey of 285 demographically representative Canadian women aged 45-65 who were current or former HRT users. RESULTS: Fifty-seven percent (57%, n = 162) of women reported either having used or considered a CAM approach for menopause. Women who had tried or considered CAM were significantly younger (mean age = 54.9 years versus 56.8 years; t(280) = 3.4, p < .05) and reported experiencing worse menopause-specific symptoms than those who had not, and these women also reported a worse experience of menopause overall. CONCLUSION: : A majority of menopausal women in the current study considered or tried CAM alternatives to HRT.     

Struggling in silence

Women who have been treated for breast cancer can experience an early menopause or the return of symptoms such as hot flushes years after they have been through the menopause. Grateful to have survived cancer, they may be reluctant to seek help for menopausal symptoms. A breast cancer menopause clinic is providing tailored support.     

An Australian study on the sociocultural context of menopause: directions for contemporary nursing practice

This research project by Berger (1997) investigates the physical, psychological, and sociocultural menopause experiences of a group of seventy women aged 45-70 years from Brisbane, Australia. Thus far the narrative provided for mid-life women shows a preoccupation with medical/biological perspectives that emphasize negative images of menopausal women as estrogen deficient and diseased. This new study is considered to be one of the few more recent attempts that investigates menopausal women within a sociocultural context and explores women's views about menopause as a normal, natural transition part of the ageing process. A qualitative approach (comprising focus groups and interviews) was aimed at women in mid-life who were willing to share their insights of this complex phase, to document individual variations and broad patterns. Findings provided enhanced understanding of many menopause aspects (such as appropriate treatment) that remain controversial. Content analysis uncovered three emerging themes: 1) contrary to popular beliefs menopause usually signified wellness; 2) apart from biological changes, the sociocultural context played a pivotal role in modifying menopause experiences; and 3) women did not feel adequately supported by health professionals. The findings signify that nurses are ideally placed to assist menopausal women in a variety of health care settings.     

A practical guide to the management of menopausal symptoms in breast cancer patients

Breast cancer is the most frequently diagnosed cancer in Canadian women. As a result of increased screening and improved treatment, more women are becoming long-term breast cancer survivors. However, due to either their treatment or prolonged survival, many of these women now have to face the consequences of premature menopause and prolonged estrogen deprivation. Hormone replacement therapy/estrogen replacement therapy (HRT/ERT) has, in the past, been recommended to healthy women at menopause not only for relief of short-term menopausal changes, particularly hot flashes, but also for its benefits on bone density, fracture reduction, and genitourinary symptoms. Recent studies have demonstrated that not only is HRT associated with an increased risk of developing breast cancer, but it also has been shown to increase the risk of recurrence in those with a breast cancer history. Until the safety of HRT/ERT in breast cancer patients can be more fully clarified, it would be wise to develop alternative strategies for the management of menopausal symptoms in these patients. This paper will discuss nonestrogen-based therapies for hot flashes, osteoporosis, and genitourinary symptoms, with emphasis on efficacy and safety in breast cancer survivors.