Serum estradiol above the postmenopausal level after chemotherapy-induced amenorrhea in breast cancer patients

Abstract

Background: Cytotoxic drugs suppress ovarian function and induce permanent or transient amenorrhea in one-to two-thirds of women. Suppression of ovarian function is effective therapy for premenopausal women with hormone receptor-positive breast cancer. Aromatase inhibition is effective for postmenopausal women with hormone receptor-positive breast cancer, but is not indicated in premenopausal women. Objective: We aim to determine whether, and for how long, ovarian estrogen production persists after chemotherapy-induced amenorrhea. Materials & methods: Serum estradiol, follicle-stimulating hormone and luteinizing hormone levels were determined in 56 breast cancer patients, 1-34 months after the onset of chemotherapyinduced amenorrhea. In 18 patients, these values were determined more than once. Postmenopausal estradiol levels are less than 10 pg/ml, follicle-stimulating hormone and luteinizing hormone greater than 20 mIU/ml. Results: The estradiol level was greater than 9 pg/ml at least once in 42 out of 56 patients. For 75 determinations, the estradiol level ranged from less than 10 to 344 pg/ml, with a median of 25 pg/ml and a mean of 41 pg/ml. Estradiol levels were not significantly correlated with either the number of months after the onset of amenorrhea at which they were drawn, or follicle-stimulating and luteinizing hormone levels. Conclusions: Ovarian estradiol production often persists for 1 year or more after chemotherapy-induced amenorrhea.

The Effect of Chemotherapy on Estradiol Levels in Patients with HER 2-Overexpression Breast Cancer in Dr Moewardi General Hospital, Surakarta, Indonesia

“…These drugs can also suppress the function of the ovaries so that they can reduce the production of endogenous estrogen [26]. Chemotherapy can also cause menopause in 50% of women under 40 years and 86% over 86 years in patients with HER positive due to suppressing the Ovarian Leutenizing Hormone-Release Hormone (LH-RH) [27]. Research carried out by Stephan Pam (2019) reported the suppression of estradiol in patients with combination chemotherapy and post-chemotherapy treatment; estradiol levels also showed a decrease.…”

Optimal Systemic Therapy for Early Breast Cancer in Women: A Clinical Practice Guideline

“…Cessation of menses does not necessarily denote the absence of ovarian function, and premenopausal estradiol levels can be found in patients with chemotherapyinduced amenorrhea 47 . In addition, hormone levels and the absence of menses are unreliable indicators of menopause during treatment with tamoxifen 48 .…”

Controversies in preservation of ovary function and fertility in patients with breast cancer

“…Furthermore remains the question whether amenorrhea can be satisfactorily used as criteria for the hormonal situation in general. Braverman et al [27] could determine premenopausal hormone serum values in 12 (75%) out of 16 patients after 3 month of amenorrhea due to chemotherapy. The inadequate definition of amenorrhea queries also results of previous studies [28][29][30] regarding the additional effect of ovarian ablation with or without tamoxifen after chemotherapy.…”