Chemotherapy-Related Amenorrhea and Menopause in Young Chinese Breast Cancer Patients: Analysis on Incidence, Risk Factors and Serum Hormone Profiles

Abstract

PurposeIn this prospective cross-sectional study on young premenopausal breast cancer patients, the objectives were to: determine the incidences of chemotherapy-related amenorrhea (CRA) and menopause (CRM); identify associated factors; and assess plasma levels of estradiol (E2) and follicular stimulating hormone (FSH) among patients who developed menopause.MethodsEligibility criteria include Chinese stage I-III breast cancer patients, premenopausal, age ≤45 at breast cancer diagnosis, having received adjuvant chemotherapy, within 3–10 years after breast cancer diagnosis. Detailed menstrual history prior to and after adjuvant treatment was taken at study entry. Patients’ background demographics, tumor characteristics and anti-cancer treatments were collected. The rates of CRA and CRM were determined. Analysis was conducted to identify factors associated with CRM. For postmenopausal patients, levels of E2 and FSH were analyzed.Results286 patients were recruited; the median time from breast cancer diagnosis to study entry was 5.0 years. 255 patients (91.1%) developed CRA. Of these, 66.7% regained menstruation. At the time of study entry, 137 (48.9%) had developed CRM, amongst whom 84 were age ≤45. On multivariate analysis, age was the only associated factor. Among patients with CRM, the median FSH was 41.0 IU/L; this was significantly lower in those who were taking tamoxifen compared to those who were not (20.1 vs. 59.7 IU/L, p<0.0001). The E2 level was <40 pmol/L; there was no difference between those who were still on tamoxifen or not.ConclusionAfter adjuvant chemotherapy, the majority of young Chinese breast cancer patients developed CRA; ~50% developed CRM, with 61% at age ≤45. Age at diagnosis is the only factor associated with CRM. FSH level may be affected by tamoxifen intake.

Menopausal symptoms in relationship to breast cancer-specific quality of life after adjuvant cytotoxic treatment in young breast cancer survivors

“…TCM is often adopted among Chinese patients in an attempt to alleviate menopausal symptoms. Indeed, interventional studies have suggested the potential efficacy of pharmacological and non-pharmacological maneuvers as well as complementary medicine in relieving side effects including that of vasomotor symptoms due to anti-cancer therapy [33][34]. When MENQOL was assessed together with outcomes of FACT-B + 4, patients who had worse menopausal symptoms were associated with poorer breast cancer-specific QoL in all aspects, reflecting a wide dimension of QoL impairment with the occurrence of menopausal symptoms.…”

Comparison of Various Tissue and Cell Therapy Approaches When Restoring Ovarian, Hepatic and Kidney’s Function After Chemotherapy-Induced Ovarian Failure

“…Premature ova rian failure (POF) is observed in 1% of women under 40 and 0.1% under 30 years, among those 37% is due to iatrogenic causes (mainly after onco logy treat ment), 25% -to idiopathic, 19% -to genetic, 19%to autoimmune [1,2]. Complications of premature menopause are not only the lack of fertility, decreased libido and amenorrhea, but also a sharp deterioration in the quality of life, psychoemotional disorders, os teoporosis, increased mortality from cardiovascular diseases and strokes [3,4]. Traditional hormone therapy requires constant drug intake, has a number of limitations, does not restore fertility and does not correct pathological changes in target organs [5].…”

“…The most curative and numerous groups of the patients with POF are the women with iatrogenic and autoimmune origin of the disease [1,3,8]. It should be noted that the use of methods of cell and tissue therapy, unambiguously shown in autoimmune dis eases, is controversial in the patients with oncologic pathology.…”

The Effects of Cancer Therapy on Women’s Fertility: What do We Know Now?

“…In patients, receiving chemotherapy with cyclophosphamide, methotrexate and 5-fluorouracil, the risk for the development of amenorrhea is around 20% in patients below the age of 30 years; however, greater than 80% in women above the age of 40 years [40]. Another study showed a risk for development of menopause in breast cancer patients below less than or equal to 35 years of age of approximately 3% and in patients, aged 40-45 years, a risk of 76% [41].…”