Chemotherapy-Related Amenorrhea in Breast Cancer: Review of the Main Published Studies, Biomarkers of Ovarian Function and Mechanisms Involved in Ovarian Toxicity

Breast carcinoma is the most common cancer in women of reproductive age. In Europe and in the United States, approximately 30% of all breast cancers occur before menopause and 15% of women are diagnosed in the reproductive age (age of 45 or younger). Adjuvant chemotherapy prolongs disease-free survival (DFS) and overall survival (OS), especially in young women, but also induces long-term and severe side effects such as temporary or definitive ovarian function suppression which results in potential loss of fertility and premature exposure to the risks of menopause including cardiovascular diseases, osteoporosis, hot flashes and genitourinary dysfunctions Bines et al. (1996). The probability of menopause with chemotherapy depends on the type of regimen used and on the age of the patient. In the literature, the estimated risk of amenorrhea varies between 0% and 60% in women younger than 40 years and between 40% and 100% in women older than 40 years. Beyond age and the type of regimen used, important variations reflect different durations of follow-up and variable definitions of menopause and of chemotherapy-related amenorrhea Bines et al. (1996).