Editor's Choice US editor's choice

Menstrual function and dysfunction

BMJ 2007; 334 doi: https://doi.org/10.1136/bmj.39106.368553.1F (Published 25 January 2007) Cite this as: BMJ 2007;334:0-a
  1. Douglas Kamerow, US editor (dkamerow{at}bmj.com)

    The standard recommendation for women wanting to become pregnant after breast cancer treatment is to wait two years. Angela Ives and colleagues studied (doi: 10.1136/bmj.39035.667176.55) 62 Australian women with breast cancer who subsequently conceived. They found that, for women with localized disease, conception as early as six months after completing treatment was unlikely to reduce survival. The two year recommendation may be valid for women with systemic disease or who are still receiving treatment. In an accompanying editorial (doi: 10.1136/bmj.39098.376181.BE), Emily Banks and Gillian Reeves state that actually very few women become pregnant after breast cancer treatment. They are clearly a special group and probably have better prognostic factors than women who don't get pregnant, regardless of when they conceive. Because randomized trials that would test conception timing are, of course, not possible, we will never know for certain the best time to become pregnant after breast cancer. As with many medical uncertainties, the best we can do is to carefully and fully inform patients who are making this decision.

    Menstrual disturbances, mostly subtle, occur in almost 80 percent women who are very active physically. In an editorial (doi: 10.1136/bmj.39043.625498.80) Cathy Speed briefly reviews this topic, pointing out that women who have the most serious sports related menstrual dysfunction are usually participants in lightweight sports—distance running, gymnastics, and lightweight rowing—and may have eating disorders as well. Long term effects are greatest in young women who begin intense exercise before menarche. Secondary amenorrhea occurs in up to 44% of women who exercise vigorously, however. They need to be evaluated and counseled to ensure that their diets are adequate in calories, calcium, and vitamin D.

    Two clinical papers are also of interest this week. Luke Bennetto et al review (doi: 10.1136/bmj.39085.614792.BE) the diagnosis and management of trigeminal neuralgia. This uncommon but characteristic syndrome is defined by sudden and severe lancinating pain within the trigeminal nerve distribution. The attacks are brief (seconds to minutes), precipitated by triggers, and similar in individual patients. Although improved imaging techniques are revealing nerve compression in an increasing number of patients, the diagnosis is still a clinical one. The standard drug treatment is carbamazepine, with surgery reserved for patients who don't respond to medications.

    When a chest radiograph confirms a large pleural effusion, what should be done next? N M Rahman and associates recommend (doi: 10.1136/bmj.39061.503866.0B) a diagnostic pleural aspiration (but not complete drainage), which has a 60% sensitivity for malignant cells. If the tap is not diagnostic, perform a chest and abdominal computed tomography, which can almost always find a lung carcinoma or abdominal malignancy that is causing the effusion. Thoracoscopy can be used as a diagnostic technique when CT scanning has failed or for complete drainage and pleurodesis when this is required.

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