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 with BC 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-stage BC. In addition, reports have suggested that embryo/oocyte cryopreservation may increase the chance of pregnancy after the diagnosis of BC, although such data remain limited. Expert opinion Commonly experienced by pre-menopausal women with BC, anti-cancer treatment could cause severe menopausal symptoms. Temporary ovarian suppression with GnRHa during chemotherapy provided a safe and efficient strategy to reduce the likelihood of chemotherapy-induced POI in premenopausal patients with early-stage BC undergoing (neo)-adjuvant chemotherapy.