title: Reproductive health and endocrine disruption in women with breast cancer: a pilot study.
abstract: OBJECTIVE
  The purpose of this study was to assess whether incorporation of an original reproductive health assessment and algorithm into breast cancer care helps providers appropriately manage patient reproductive health goals and to follow laboratory markers for fertility and correlate these with menstruation.
  
  
  METHODS
  This prospective observational pilot study was set in an urban, public hospital. Newly diagnosed premenopausal breast cancer patients between 18 and 49 years old were recruited for this study prior to chemotherapy initiation. As the intervention, these patients received a reproductive health assessment and care per the study algorithm at 3-month intervals for 24 months. Blood samples were also collected at the same time intervals. The main outcome measures were to assess if the reproductive health management was consistent with patient goals and to track any follicle-stimulating hormone (FSH) and thyroid-stimulating hormone (TSH) level changes throughout treatment and post-treatment period.
  
  
  RESULTS
  Two patients were pregnant at study initiation. They received obstetric consultations, opted to continue pregnancies, and postpone treatment; both delivered at term without complications. One woman desired future childbearing and received fertility preservation counseling. All women received family planning consultations and received/continued effective contraceptive methods. Seventy-three percent used long-term contraception, 18 % remained abstinent, and 9 % used condoms. During chemotherapy, FSH rose to menopausal levels in 82 % of patients and TSH rose significantly in 9 %. While 82 % of women experienced amenorrhea, 44 % of these women resumed menstruation after chemotherapy.
  
  
  CONCLUSIONS
  The assessment and algorithm were useful in managing patients' reproductive health needs. Chemotherapy-induced endocrine disruption impacted reproductive health.
authors.affiliation: Division of Family Planning, Department of Obstetrics and Gynecology, John H. Stroger, Jr. Hospital of Cook County, 1900 W. Polk St., Room #435, Chicago, IL, 60612, USA, ashleshapatel16@yahoo.com.
authors.forename: Ashlesha
authors.initials: A
authors.lastname: Patel
authors.forename: Alicia
authors.initials: A
authors.lastname: Roston
authors.forename: Almae
authors.initials: A
authors.lastname: Uy
authors.forename: Erika
authors.initials: E
authors.lastname: Radeke
authors.forename: Arden
authors.initials: A
authors.lastname: Roston
authors.forename: Louis
authors.initials: L
authors.lastname: Keith
authors.forename: H A
authors.initials: HA
authors.lastname: Zaren
mesh_terms: D000328:Adult; D000465:Algorithms; D000568:Amenorrhea / Q000139:chemically induced; D001943:Breast Neoplasms / Q000097:blood / Q000188:drug therapy; D003267:Contraception / Q000379:methods; D004358:Drug Therapy / Q000379:methods*; D052244:Endocrine Disruptors / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D005298:Fertility; D059247:Fertility Preservation / Q000379:methods; D005640:Follicle Stimulating Hormone / Q000097:blood*; D006801:Humans; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010346:Patient Care Management / Q000379:methods; D010865:Pilot Projects; D011247:Pregnancy; D017697:Premenopause; D011446:Prospective Studies; D060728:Reproductive Health / Q000706:statistics & numerical data*; D013972:Thyrotropin / Q000097:blood*; D014481:United States
chemical_list: D052244:Endocrine Disruptors; D005640:Follicle Stimulating Hormone; D013972:Thyrotropin