Observation And Analysis Of Adjuvant Chemotherapy-Induced Amenorrhea Via Tests Of Serum Hormone Levels In Premenopausal Breast Cancer Patients

Objective:We observe menstrual history transition and monitor levels of serum estradiol (E2) and follicle-stimulating hormone (FSH) in premenopausal breast cancer patients who had undergone adjuvant chemotherapy, to investigate influencing factors of chemotherapy-induced amenorrhea (CIA) and to identify their ovarian function and actual menstrual statuses as a base of choice for endocrine therapy.Materials and Methods:We retrospectively analyzed menstrual statuses and serum E2and FSH levels in92premenopausal breast cancer patients who underwent standard adjuvant chemotherapy. Relations among menstrual statuses, hormone levels, and changes in menstrual history were assessed. Proportions were compared using Fisher’s exact tests and chi-square tests to determine the relationship with CIA. The Kaplan-Meier method and chi-square was used to estimate survival distributions for DFS. Serum E2and FSH were compared in different groups using T-test.Results:The median patient age was46years (range,27-55) and the median follow-up duration was34months (range,18-72). Seventy-six women (82.6%) developed CIA after initial adjuvant chemotherapy,31cases returned to normal menses. Age was a major predictor for the occurrence of CIA, menstrual resumption and menopause. The onset of CIA was more frequent in patients over age45. Resumption of menstruation was more frequent in patients less than45years old (P<0.0001), median time of menstrual recovery after amenorrhea was7months.39.1%patients’E2and FSH levels reached the range of postmenopausal after CIA, mainly in cases older than45years (P<0.0001). The occurrence of CIA didn’t have relationship with using Tamoxifen, trastruzumab or different chemotherapies. Tamoxifen increased risk of menopause regardless of age (P<0.0001). Relapse and metastasis occurred in10patients, and there was no significant difference between CIA and absence of CIA groups.9.8%patients were persisting amenorrhea, but the serum hormone statuses were still in premenopausal levels. Levels of FSH and E2in different Groups of absence of CIA, menstrual recovery after CIA and menopause after CIA had statistical differences (P<0.05).11CIA patients’sex hormone levels reached menopause state before menstrual recovery,3of which are still in the state of menopause when vaginal bleeding occurred. Conclusions:Age was an independent and major predictor for the occurrence of CIA, menstrual resumption and menopause. Patients younger than45years old seem to get ovarian function recovery likely, so they need long-term sex hormone level monitoring to identify ovarian function and actual menstrual statuses. Patients older than45years receiving TAM treatment and undergoing long-term amenorrhea, if continuous detection of hormone level in postmenopausal state, should consider initiating endocrine treatment as postmenopausal patients.