乳癌婦女化療引起閉經之現象及其更年期症狀表現

Chemotherapy-Induced Amenorrhea and Menopause Symptoms in Women With Breast Cancer

化學治療（化療）為乳癌常見輔助治療，它可以藉由殺死殘餘癌細胞而提升乳癌的治療存活率。但化療藥物會破壞卵巢內生殖細胞，中斷女性生殖內分泌週期，使乳癌婦女出現化療引起閉經（chemotherapy-induced amenorrhea, CIA）現象。CIA發生率會因對閉經的定義不同而有不同，約有75%未停經乳癌婦女在接受化療後會產生CIA。年齡愈大、化療週期愈長、ER（estrogenreceptor）接受體為陽性及Tamoxifen的使用，均會提高CIA的風險。雖CIA可延長整體存活率及無病存活率，但也使婦女必須提早面對一系列因雌性激素下降所引發的更年期症狀（例如：認知功能、身體症狀、心理症狀、血管舒縮症狀、生殖及性功能、以及體重變化等）。本文描述了女性的生殖週期、CIA的機轉、CIA危險因子、CIA所引發的更年期症狀群及更年期症狀的評估方法，與五個常見評估症狀量表之比較。健康照護及研究者在了解所有可能的更年期症狀之後，可依情境需求選擇合適的評估工具，針對面臨更年期症狀的乳癌婦女進行症狀表現評估。

Chemotherapy is a common adjuvant therapy for breast cancer that improves survival rates by killing residual cancer cells. However, this intervention may damage the germ cells within the ovary and interrupt the menstrual cycle, ultimately leading to chemotherapy-induced amenorrhea (CIA). The incidence of CIA depends on how broadly this term is defined. Around 75% of premenopausal breast cancer women treated with chemotherapy will develop CIA. Age, having a relatively long chemotherapy cycle duration, being estrogen-receptor positive, and using Tamoxifen all increase the risk of CIA. Although CIA may be associated with better prognosis outcomes, breast cancer women must subsequently deal with the various menopausal symptoms that are associated with a CIA-induced drop in estrogen level (such as cognitive function decline, physical and psychological symptoms, vasomotor symptoms, reproductive and sexual function problems, and body weight change). The present article describes the female menstrual cycle, the mechanism and risk factors of CIA, and the range of menopausal symptoms. Furthermore, we summarized methods of assessing menopausal symptoms and compared five common rating scales of menopausal symptoms. By better understanding the potential menopausal symptoms, researchers and clinicians may then select the most appropriate scale based on the situational needs in order to evaluate the severity of menopausal symptoms that are experienced by breast cancer women.