title: Incidence and time course of bleeding after long-term amenorrhea after breast cancer treatment: a prospective study.
abstract: BACKGROUND
  The incidence of chemotherapy-induced amenorrhea (CIA) and the time to subsequent menstrual bleeding in premenopausal breast cancer patients treated with current standard chemotherapy regimens was examined.
  
  
  METHODS
  Four hundred sixty-six women ages 20 to 45 years at the time of diagnosis of a stage I to III breast cancer were recruited between January 1998 and July 2002. Patients completed monthly bleeding calendars from the time of study recruitment. Updated medical history data were obtained at 6-month intervals.
  
  
  RESULTS
  Most women received doxorubicin and cyclophosphamide (AC); doxorubicin, cyclophosphamide, and paclitaxel (ACT); or cyclophosphamide, methotrexate, and 5-fluorouracil (CMF). Approximately 41% of women experienced an initial 6 months of CIA, and an additional 29% had at least 1 year of CIA. Approximately half of the women with 6 months of CIA and 29% of those with 1 year of CIA resumed bleeding within the subsequent 3 years, usually in the year after their amenorrheic episode. Resumption of bleeding differed significantly by treatment regimen after 6 months of CIA (P = .002; 68% with AC, 57% with ACT, and 23% with CMF), but not after 1 year of CIA (P = .5). Of the 23% of women who experienced an initial 2-year period of CIA, 10% resumed bleeding within the ensuing 3 years after their amenorrheic episode, but none had regular menses.
  
  
  CONCLUSIONS
  A considerable proportion of women treated with chemotherapy will experience periods of CIA, but many will resume bleeding. Newer treatment regimens such as ACT appear to have a higher resumption of bleeding compared with CMF. This finding may have implications for choice of anti-estrogen treatment and for future potential pregnancies/fertility.
authors.affiliation: Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee-Women's Hospital of the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213, USA. psukumvanich@mail.magee.edu
authors.forename: Paniti
authors.initials: P
authors.lastname: Sukumvanich
authors.forename: L Doug
authors.initials: LD
authors.lastname: Case
authors.forename: Kimberly
authors.initials: K
authors.lastname: Van Zee
authors.forename: S Eva
authors.initials: SE
authors.lastname: Singletary
authors.forename: Electra D
authors.initials: ED
authors.lastname: Paskett
authors.forename: Jeanne A
authors.initials: JA
authors.lastname: Petrek
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Naftalis
authors.forename: Michelle J
authors.initials: MJ
authors.lastname: Naughton
mesh_terms: D000328:Adult; D000367:Age Factors; D000568:Amenorrhea / Q000139:chemically induced / Q000453:epidemiology*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D001943:Breast Neoplasms / Q000150:complications / Q000188:drug therapy*; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015994:Incidence; D008598:Menstruation; D017697:Premenopause; D011379:Prognosis; D013997:Time Factors