# Impact of LHRHa Therapy on Relationship Dynamics and Sexual Coercion in Premenopausal Breast Cancer Patients: A Multicenter Cross-Sectional Study

## TL;DR

LHRHa therapy in premenopausal breast cancer patients is linked to increased sexual coercion and relationship strain, especially in younger women.

## Contribution

This study is the first to show a link between LHRHa-induced menopause and increased sexual coercion in breast cancer patients.

## Key findings

- LHRHa users had significantly higher SCIRS scores in all domains compared to tamoxifen users.
- Younger patients (≤36 years) experienced greater coercion exposure across all domains.
- Commitment Manipulation showed the largest effect size, indicating deeper relational strain.

## Abstract

What are the main findings?
Premenopausal breast cancer patients receiving LHRHa therapy showed significantly higher SCIRS scores across all domains compared with tamoxifen users.The Commitment Manipulation domain demonstrated the largest difference, indicating deeper relational strain associated with abrupt medical menopause.

Premenopausal breast cancer patients receiving LHRHa therapy showed significantly higher SCIRS scores across all domains compared with tamoxifen users.

The Commitment Manipulation domain demonstrated the largest difference, indicating deeper relational strain associated with abrupt medical menopause.

What are the implications of the main findings?
Findings highlight the need for routine psychosocial and sexual health screening in patients starting or receiving LHRHa therapy.Clinicians should consider age-sensitive supportive interventions, as younger women exhibited greater vulnerability to coercive relationship dynamics.

Findings highlight the need for routine psychosocial and sexual health screening in patients starting or receiving LHRHa therapy.

Clinicians should consider age-sensitive supportive interventions, as younger women exhibited greater vulnerability to coercive relationship dynamics.

Background/Objectives: Luteinizing hormone-releasing hormone agonists (LHRHa) are widely used to induce ovarian suppression in premenopausal women with hormone receptor-positive breast cancer. Although effective, abrupt medical menopause may negatively affect sexual health and intimate partner interactions. Sexual coercion—ranging from manipulation to explicit pressure—remains an underrecognized psychosocial burden in oncology. This multicenter study aimed to evaluate the association between LHRHa therapy and sexual coercion, including relational dynamics measured through the Sexual Coercion in Intimate Relationships Scale (SCIRS). Methods: This cross-sectional study included 81 premenopausal breast cancer patients receiving endocrine therapy at three tertiary centers in Türkiye. Participants were categorized into tamoxifen monotherapy users (n = 39) and LHRHa users (n = 42). Sexual coercion was assessed using the validated Turkish SCIRS, which includes Resource Manipulation/Violence, Defection Threat, and Commitment Manipulation domains. Mann–Whitney U, Kruskal–Wallis, and ANCOVA analyses were performed, adjusting for age, treatment duration, surgery type, chemotherapy, radiotherapy, and education level. The study was ethically approved (2023-KAEK-148) and prospectively registered (NCT06840847). Results: LHRHa users demonstrated significantly higher SCIRS scores across all domains compared with non-users (RM/V: p = 0.039; DT: p = 0.001; CM: p < 0.001; Total: p = 0.004). ANCOVA confirmed LHRHa therapy as an independent predictor after adjusting for covariates (p = 0.001–0.006). The largest effect was observed in the Commitment Manipulation domain (partial η2 = 0.177). Younger patients (≤ 36 years) reported significantly greater coercion exposure across all domains (p = 0.018–0.042). Conclusions: LHRHa therapy is associated with increased sexual coercion and strained relational dynamics in premenopausal breast cancer patients, particularly among younger women. These findings emphasize the need for routine sexual health assessment, confidential psychosocial screening, and age-sensitive supportive interventions in endocrine therapy management.