J Breast Cancer.  2009 Mar;12(1):20-26. 10.4048/jbc.2009.12.1.20.

The Incidence of Chemotherapy-induced Amenorrhea and Recovery in Young (<45-year-old) Breast Cancer Patients

• Kim HA
• Shin DS
• Moon NM
• Paik NS
• Noh WC

• KMID: 2286574
• DOI: http://doi.org/10.4048/jbc.2009.12.1.20

Abstract

PURPOSE: Although adjuvant chemotherapy improves the survival of premenopausal breast cancer patients, it could induce the premature menopause. The objective of this study was to investigate the incidence and risk factors of chemotherapy-induced amenorrhea (CIA) and recovery for young (< 45-year-old) breast cancer patients.
METHODS
We examined patients with primary invasive breast cancer who had been treated with surgery and adjuvant chemotherapy from January 2003 to June 2006. All of the patients were younger than 45 year and they had regular menstruation at the time of diagnosis. Amenorrhea was defined as the absence of menstruation for three consecutive months or a serum follicular stimulating hormone level > 30 mIU/mL.
RESULTS
A total of 324 patients were included in this study. Of these patients, 261 patients (80.6%) developed amenorrhea just after the completion of chemotherapy. During follow-up, 77 patients (29.5%) resumed menstruation. Amenorrhea rates at 6, 12, 24, and 36 months after chemotherapy were 72.2%, 66.6%, 58.1%, and 55.5%. Women who recovered from amenorrhea were significantly younger than the women who did not recover (p<0.001). Patients treated with cyclophosphamide, methotrexate and 5-fluorouracil (CMF) less frequently recovered from amenorrhea than patients who were treated with anthracycline or taxane-based chemo- therapy (p<0.001).
CONCLUSION
The age of the patient was the most important factor for the development of CIA. Patients treated with a CMF regimen and older patients showed poor recovery from CIA. These results could be helpful to make decisions about the treatment strategies for premenopausal young women.

Keyword

Amenorrhea; Breast cancer; Chemotherapy; Ovarian suppression; Premature menopause

MeSH Terms

Amenorrhea
Antineoplastic Combined Chemotherapy Protocols
Breast
Breast Neoplasms
Chemotherapy, Adjuvant
Cyclophosphamide
Female
Fluorouracil
Follow-Up Studies
Humans
Incidence
Menopause, Premature
Menstruation
Methotrexate
Risk Factors
Antineoplastic Combined Chemotherapy Protocols
Cyclophosphamide
Fluorouracil
Methotrexate