Recognizing menopause in women with amenorrhea induced by cytotoxic chemotherapy for endocrine-responsive early breast cancer

Abstract

Cytotoxic anticancer treatment may induce amenorrhea or menopause to a variable extent. These side effects may not only impair or impede fertility but also cause sexual dysfunction, bone loss, and menopausal symptoms, with a strikingly negative effect on quality of life in many women. Aromatase inhibitors (AIs) are a recommended adjuvant endocrine treatment option in postmenopausal patients affected by early breast cancer (EBC) but are contraindicated in premenopausal women and in those with residual ovarian function. Women over 40 years of age with chemotherapy-induced amenorrhea (CIA) and routine hormonal levels consistent with menopause may receive an AI as adjuvant endocrine treatment. For these women, the tools available to identify menopause do not appear to be completely reliable. This review focused on the pathophysiology of ovarian toxicity induced by cytotoxic agents and on potentially useful methods to diagnose chemotherapy-induced menopause in patients treated with adjuvant chemotherapy for endocrine-responsive EBC. Moreover, practical approaches are proposed to distinguish true menopausal women, who would benefit from AIs, from those with transient or persistent CIA.

Chemotherapy-induced ovarian toxicity in patients affected by endocrine-responsive early breast cancer

“…In clinical practice, ascertaining residual ovarian activity in a premenopausal patient with endocrine-responsive EBC and CRA is of key importance not only to define the fertility potential following completion of CT, but also to select the appropriate adjuvant ET (tamoxifen versus AI) [114]. To this aim, AMH may be used as suggested in Fig.…”

MR Imaging-based Evaluation of Morphological Changes in the Uterus and Ovaries of Patients Following Neoadjuvant Chemotherapy for Cervical Cancer

“…7 MR imaging scanning protocol MR imaging studies were performed using a 3.0-tesla (Skyla µ or Trio; Siemens AG, Erlangen, Germany) or 1.5T (Avanto µ ; Siemens AG, Erlangen, Germany) machine. The protocols included axial T 2 -weighted images (WI), oblique axial T 2 -WI, and sagittal T 1 -and T 2 -WI.…”

“…[3][4][5] Ultrasonographic (US) assessment of the antral follicle count (AFC) and ovarian volume are used to assess ovarian reservation after chemotherapy. 6,7 More particularly, it is generally considered that the AFC can provide reliable assessment of a patient's fertility status and risk of POF. To the best of our knowledge, no report has described the use of MR imaging of the female reproductive organs following chemotherapeutic treatment.…”

Gonadal Function and Reproductive Health in Women with Human Immunodeficiency Virus Infection

“…Besides the physiologic anovulatory states prior to menarche and following menopause, anovulation can occur with perturbations of ovarian, hypothalamic or pituitary functions. Chronic illness and disruptions of energy balance can result in anovulation, which is commonly reported in relationship to wasting illnesses, low body fat, receipt of a variety of medications and drugs including cancer chemotherapies 7, 8 , immune modulators 9 , antiepileptics 10, 11 , antipsychotics 10, 12 , opioids 13, 14 and others. Several of these factors, such as wasting 15 , and use of a variety of medications are common among HIV infected women.…”