Chemotherapy-Induced Amenorrhea – An Update

Abstract

Because of the heterogeneity in the definition of chemotherapy-induced amenorrhea (CIA) there are distinct differences in the literature with regard to its incidence as well as its dependence on various influencing factors. The occurrence of CIA varies greatly depending on the applied chemotherapy. The pathogenesis of CIA is especially based on a reduction of ovarian reserves. Various sonographic and biochemical factors can be used to exclude or confirm CIA. This is particularly important when an endocrine therapy with tamoxifen is not possible and the use of aromatase inhibitors is under consideration. CIA and especially the frequently thereby resulting early menopause can lead to pronounced restrictions in the quality of life of the affected patients, not least due to the resulting infertility. On the other hand, various studies have shown that CIA may have a positive prognostic significance. Thus, the identification of measures to prevent CIA (for example, through the use of GnRH analogues) is of particular importance.

Zusammenfassung

Aufgrund der Heterogenität in der Definition der chemotherapieinduzierten Amenorrhö (CIA) bestehen deutliche Unterschiede in der Literatur bez. ihrer Häufigkeit sowie der Abhängigkeit von verschiedenen Einflussfaktoren. Das Auftreten einer CIA variiert deutlich in Abhängigkeit von der angewandten Chemotherapie. Pathogenetisch liegt der CIA insbesondere eine Reduktion der ovariellen Reserve zugrunde. Verschiedene Ultraschall- und biochemische Faktoren können zum Ausschluss bzw. zur Feststellung einer CIA verwendet werden. Dies ist insbesondere dann wichtig, wenn eine endokrine Therapie mit Tamoxifen nicht möglich ist und der Einsatz von Aromatasehemmern erwogen wird. Eine CIA und insbesondere die daraus häufig resultierende vorzeitige Menopause können zu einer deutlichen Einschränkung der Lebensqualität der betroffenen Patientin, nicht zuletzt durch die resultierende Infertilität führen. Andererseits haben verschiedene Studien zeigen können, dass der CIA eine positive prognostische Bedeutung zukommen könnte. Daher kommt der Identifikation von Maßnahmen zur Vermeidung einer CIA (beispielsweise durch den Einsatz von GnRH-Analoga) ein besonderer Stellenwert zu.

Key words

chemotherapy-induced amenorrhea - breast cancer - chemotherapy - GnRH analogues

Schlüsselwörter

chemotherapieinduzierte Amenorrhö - Mammakarzinom - Chemotherapie - GnRH-Analoga

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