Analysis Of Relevant Factors In Chemotherapy-Induced Amenorrhea And Assessment Of Menstrual Status

Background:We investigate influencing factors of chemotherapy-induced amenorrhea (CIA), such as age, use of Tamoxifen, use of Trastuzumab and different chemotherapies. And we evaluated menstrual history transition by monitoring levels of serum estradiol (E2) and follicle-stimulating hormone (FSH) in premenopausal breast cancer patients to identify their actual menstrual statuses as a base of choice for endocrine therapy.Patients and Methods:We retrospectively analyzed menstrual statuses and serum E2 and FSH levels in 158 premenopausal breast cancer patients who underwent standard adjuvant chemotherapy. Relations between menstrual statuses, hormone levels, and changes in menstrual history were assessed. Proportions were compared using chi-square tests and Fisher’s exact tests to determine the relationship with CIA. Duration of CIA and time of CIA occurrence were compared in different chemotherapies using Wilcoxon Rank Sum Test. One-way analysis of variance (ANOVA) was performed to examine difference of hormone level and menstrual statuses.Results:The median patient age was 45 years old (range,27-55), and the median follow-up duration was 26 months (range,14-65).138 women (87.3%) developed CIA after initial adjuvant chemotherapy. Age was a major factor for the occurrence of chemotherapy-induced amenorrhea (CIA), menstrual resumption and menopause. The onset of CIA was more frequent in patients over age 45.49 women of CIA patients recover the menstruation, it’s more frequent in patients over age 45 (P< 0.0001), median time of menstrual recovery after amenorrhea was 6 months.32.3% patients’ E2 and FSH levels reached the range of postmenopausal after CIA in follow-up, mainly in patients over age 45 (P< 0.0001). The occurrence of CIA didn’t have relationship with use of Tamoxifen, Trastuzumab or different chemotherapies. The duration of CIA and time of CIA occurrence show no difference in different chemotherapies. Tamoxifen increased risk of menopause regardless of age (P=0.025). Levels of E2 and FSH in different Groups of menstrual recovery after CIA and menopause after CIA had statistical differences (P< 0.0001).Conclusion:Age was the major factor for the occurrence of CIA, menstrual resumption and menopause. The potential of ovarian function recovery is greater in patients younger than 45 years old. It’s important and necessary for long-term sex hormone level monitoring in perimenopause patients to identify ovarian function and actual menstrual statuses. Patients over age 45 should consider as postmenopausal patients and change endocrine treatment from TAM to AIs, if continuous detection of hormone level in postmenopausal state.