The risk of menopausal symptoms in premenopausal breast cancer patients and current pharmacological prevention strategies

ABSTRACT

Introduction: For young premenopausal breast cancer (BC) patients, adjuvant chemotherapy and other anti-cancer treatments can increase the risk of menopausal symptoms and may cause chemotherapy-related amenorrhea (CRA), infertility and premature ovarian insufficiency (POI).

Areas covered: In this report, menopausal symptoms related to anti-cancer treatment are described. Menstrual disturbances associated with the use of adjuvant chemotherapy, endocrine therapy, and targeted therapy against human epidermal growth factor receptor 2 (HER2) in premenopausal women withBC are discussed. To prevent menopausal symptoms, CRA and POI, data on the efficacy of temporary ovarian suppression with gonadotropin-releasing hormone analogues (GnRHa) during chemotherapy are highlighted. Pooled analyses have confirmed that concurrent administration of GnRHa during chemotherapy could significantly reduce the risk of developing chemotherapy-induced POI in premenopausal women with early-stageBC. In addition, reports have suggested that embryo/oocyte cryopreservation may increase the chance of pregnancy after the diagnosis ofBC, although such data remain limited.

Expert opinion: Commonly experienced by pre-menopausal women withBC, anti-cancer treatment could cause severe menopausal symptoms. Temporary ovarian suppression with GnRHa during chemotherapy provided asafe and efficient strategy to reduce the likelihood of chemotherapy-induced POI in premenopausal patients with early-stageBC undergoing (neo)-adjuvant chemotherapy.

KEYWORDS:

• Pre-menopausal
• breast cancer (BC)
• menopausal symptoms
• premature ovarian insufficiency (POI)
• chemotherapy-related amenorrhea (CRA)
• gonadotropin-releasing hormone analogues (GNRHA)
• fertility preservation (FP)

Article highlights

• Premenopausal women with breast cancer, particularly younger patients, tend to develop more aggressive subtype of disease with unfavorable prognostic features; hence, optimal management for premenopausal women often necessitates a combination of different modalities of adjuvant treatment.

• The use of adjuvant chemotherapy has been associated with ovarian insufficiency, which is accompanied by severe menopausal symptoms, and may progress toward the development of premature menopause and infertility.

• Premenopausal women with breast cancer have a high risk of experiencing menopause symptoms. On the one hand, chemotherapy may induce temporary or permanent ovarian insufficiency and exacerbate menopausal symptoms. On the other hand, anti-estrogen strategies can lead to menopausal symptoms in a significant proportion of these patients.

• Concurrent administration of gonadotropin-releasing hormone analogues during chemotherapy could significantly reduce the risk of developing chemotherapy-induced premature ovarian insufficiency in premenopausal women with early-stage breast cancer.

• Fertility counseling and embryo/oocyte cryopreservation may increase the chance of pregnancy after the diagnosis of breast cancer, although such data remain limited.

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Declaration of interest

The author(s) have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.