Recognizing menopause in women with amenorrhea induced by cytotoxic chemotherapy for endocrine-responsive early breast cancer

Francesco Torino; Agnese Barnabei; Liana De Vecchis; Marialuisa Appetecchia; Lidia Strigari; Salvatore M Corsello

doi:10.1530/ERC-11-0199

Recognizing menopause in women with amenorrhea induced by cytotoxic chemotherapy for endocrine-responsive early breast cancer

Department of Internal Medicine, Chair of Medical Oncology, University of Rome “Tor Vergata”, Rome, Italy
¹Endocrinology Unit, National Institute of Cancer “Regina Elena”, Rome, Italy
²Department of Neuroscience, Chair of Medical Oncology, University of Rome “Tor Vergata”, Rome, Italy
³Laboratory of Medical Physics and Expert Systems, National Institute of Cancer “Regina Elena”, Rome, Italy
⁴Endocrinology Unit, Università Cattolica, Sacro Cuore, Rome, Italy

(Correspondence should be addressed to S M Corsello, Università Cattolica, Via Federico Cesi 72, I-00193 Rome, Italy; Email: corsello.sm{at}mclink.it)

Abstract

Cytotoxic anticancer treatment may induce amenorrhea or menopause to a variable extent. These side effects may not only impair or impede fertility but also cause sexual dysfunction, bone loss, and menopausal symptoms, with a strikingly negative effect on quality of life in many women. Aromatase inhibitors (AIs) are a recommended adjuvant endocrine treatment option in postmenopausal patients affected by early breast cancer (EBC) but are contraindicated in premenopausal women and in those with residual ovarian function. Women over 40 years of age with chemotherapy-induced amenorrhea (CIA) and routine hormonal levels consistent with menopause may receive an AI as adjuvant endocrine treatment. For these women, the tools available to identify menopause do not appear to be completely reliable. This review focused on the pathophysiology of ovarian toxicity induced by cytotoxic agents and on potentially useful methods to diagnose chemotherapy-induced menopause in patients treated with adjuvant chemotherapy for endocrine-responsive EBC. Moreover, practical approaches are proposed to distinguish true menopausal women, who would benefit from AIs, from those with transient or persistent CIA.