BMC Cancer (Apr 2025)
Clinical and biochemical amenorrhea in premenopausal patients with breast cancer treated with chemotherapy - a prospective cohort study
Abstract
Abstract Background Patients with breast cancer receiving chemotherapy frequently experience amenorrhea due to the cytotoxic effects of drugs, resulting in ovarian suppression and impacting reproductive health. This study aimed to prospectively investigate the incidence of clinical amenorrhea defined as the cessation of menstrual bleeding for at least three consecutive months and and biochemical amenorrhea, characterized by serum estradiol levels < 20 pg/mL and FSH levels ≥ 40 mIU/mL, using clinical and biochemical methods to determine their relation and identify the predictive factors for early amenorrhea. Methods This longitudinal study was conducted at a tertiary care hospital with 76 premenopausal patients with breast cancer who received chemotherapy. The patients were followed up for two years with monthly clinical assessments of amenorrhea status for a year and biannual hormonal assessments of serum estradiol and follicle-stimulating hormone (FSH) levels. The incidence of clinical and biochemical amenorrhea was estimated and explored to determine any association between the two factors and the impact of risk factors. Results The rates of clinical and biochemical amenorrhea were 84.2% and 78.9%, respectively. The median time for clinical amenorrhea was 8 ( 95% CI, 7.83–8.17) months and 18 (95% CI, 17.90–18.10) months for biochemical amenorrhea. A significant association was observed between clinical and biochemical amenorrhea (P =.0022). The estradiol and FSH levels were initially in the premenopausal range and reached postmenopausal values by the end of the study period. Age, BMI, chemotherapy regimen, hormonal treatment, and biochemical amenorrhea were not predictive of the time to clinical amenorrhea. Conclusions The occurrence of chemotherapy-related amenorrhea in premenopausal patients with breast cancer was high. Clinical amenorrhea is a reliable early indicator of biochemical amenorrhea. Regular menstrual and hormonal assessments are essential in patients with breast cancer undergoing chemotherapy. Future studies with larger cohorts are required to explore predictive factors associated with chemotherapy-related amenorrhea.
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