Relationship between Endocrine Therapy and Menstruation in Breast Cancer

Endocrine therapy, as one of the important standardized treatments for breast cancer patients with estrogen receptor or progesterone receptor positive, has the advantages of low toxicity, good tolerance and convenience, but the medication time of 5-10 years and various side effects also make many sisters suffering from this disease worry! But the first problem is the relationship between menstruation and endocrine therapy. The following will tell you step by step, hoping to give you some help. What is “menopause”? Many sisters thought they were menopausal after their menstruation “did not come” during the treatment. Menopause in the medical sense usually refers to the following three conditions: ① age > 60 years old; ② after bilateral oophorectomy; ③ For women less than 60 years old, if menopause has occurred, due to the influence of chemotherapy and endocrine therapy drugs, we usually need to monitor the levels of hormones (FSH and estradiol) for 1-2 years. If they have been at the postmenopausal level, we can judge them as menopause. Don’t panic about “menstruation” during endocrine therapy! Menstruation stops during chemotherapy and continues until endocrine therapy, and then one day during endocrine therapy, menstruation “comes” again. The arrival of menstruation makes many sisters think of the rise of estrogen in the body, and the rise of estrogen involves breast cancer, so this phenomenon makes everyone very nervous. Why is there such a phenomenon? The ovarian function of premenopausal patients will gradually recover after chemotherapy, and the onset of menstruation is a manifestation of normal ovarian function. Therefore, during endocrine therapy, “menstruation” is normal. Menstrual onset = ineffective endocrine drugs? A lot of patients think: Endocrine Medicine = Menopause Medicine, after taking medicine, menstruation no longer comes to prove medicaments has effect, estrogen was controlled, actually this is a misunderstanding. The reason is that these patients think that the ultimate effect of endocrine drugs is to “inhibit the production of estrogen”, which is not the case. Endocrine drugs are divided into two kinds, one is to prevent the combination of normal estrogen and progesterone with hormone receptors on the surface of breast cancer cells, so that estrogen can not stimulate cancer cells and stop their growth (such as tamoxifen and other premenopausal endocrine therapy drugs); Tamoxifen does not inhibit the production of estrogen, but prevents the binding of estrogen already produced to hormone receptors on the surface of breast cancer, so “menstruation” has nothing to do with the efficacy of drugs. The other is to inhibit cancer cells by directly inhibiting estrogen production (such as aromatase inhibitor AI, ovarian function inhibitor OFS). Menstruation comes during endocrine therapy, need to inject OFS (ovarian function inhibitor)? There are 3 conditions for OFS in estrogen or progesterone receptor-positive breast cancer: ① age < 35 years; ② ≥ 4 lymph node metastases; ③ no menopause after chemotherapy. The above three conditions are not applicable to OFS if one of them is met. It is necessary to determine whether the patient is a high-risk group of recurrence and metastasis, and then make a decision based on other conditions of the patient. During the period of taking tamoxifen or toremifene, menstruation came and estrogen increased after going to the hospital for examination. Is it normal? Normal. If you are not in perimenopause (a period before and after menopause), there is no need to monitor hormone levels. The reason why hormone levels are monitored during perimenopause is to determine whether the patient is menopausal, so as to decide whether to replace endocrine therapy drugs with aromatase inhibitors AI. Is it necessary to check the thickness of endometrium regularly during endocrine therapy? This issue should be discussed separately for the premenopausal, postmenopausal, and suppressive populations. Premenopausal: Tamoxifen (tamoxifen) is structurally similar to estrogen. It not only competes with normal estrogen to bind to hormone receptors on the surface of breast cancer cells, but also "impersonates" the source of estrogen in normal organs of the body (such as ovaries and uterus). Therefore, endometrial thickening is a common side effect of tamoxifen. Therefore, it is quite normal for menstrual disorders to occur during tamoxifen administration, resulting in endometrial thickening. Endometrial thickness below 19 mm (normal 4-10 mm) is acceptable, so aggressive medical procedures such as frequent curettage are of little significance. Postmenopausal: If ovarian cysts, endometrial thickening, vaginal bleeding and other abnormal conditions, the need for timely medical treatment. Intimal thickness greater than 8 mm may warrant consideration of biopsy. Suppressive therapy: Under the inhibitory effect, the uterus should be atrophic, and there will be no endometrial thickening, ovarian cysts and other problems in the process, but if there are abnormal phenomena, please seek medical treatment in time to find out the cause. Generally speaking, for premenopausal patients, after chemotherapy and menopause, "menstruation" is normal during endocrine therapy, and there is no need to be too nervous. Of course, if you really can't put it down, you can go to the hospital to communicate with the doctor. It's also important to keep a good attitude in the process of rehabilitation! Mammary gland hyperplasia Breast cancer Breast tumor Mastitis Breast cyst