Predicting Ovarian Function After Breast Cancer Chemotherapy

Breast Cancer News
March 9, 2015
By: 
Robin Warshaw, Contributing Writer
Reviewed By: 
A. Jo Chien, MD

When measured before chemotherapyinfo-icon, along with age, the level of a hormoneinfo-icon released in young women’s ovaries may predict whether the ovaries will work again after chemotherapy.

Background and Goals

Young women diagnosed with breast cancer often are treated with chemotherapy. Yet chemotherapy can damage ovaries and reduce ovarianinfo-icon follicles, the sacs that contain the eggs. Many premenopausalinfo-icon women receiving chemotherapy lose their periods for a time. Some stop menstruating, or bleeding, forever and experience early menopauseinfo-icon

Whether the ovaries start to function, or work, again after chemotherapy is usually determined by whether menstrual bleeding resumes. While bleeding does mean the ovaries have regained some degree of function, it does not prove a woman has become fertile again, or able to become pregnant.

Knowing before treatment how chemotherapy will impact ovarian function is important for young women who desire future childbearing.

A number of hormones have been associated with ovarian function in women without breast cancer and are often used in women undergoing work-up and treatment for infertilityinfo-icon. Prior studies have suggested that some of these hormones can be measured in breast cancer patients before chemotherapy and are associated with ovarian function after treatment. The researchers wanted to see if measuring hormone levels before chemotherapy could create a score to predict the likelihood of ovarian function afterwards.

Design

The study enrolled 124 total women between the ages of 18 and 45, with newly diagnosed early-stage breast cancerinfo-icon at two centers in California and Pennsylvania. All patients received chemotherapy.

The women’s blood was tested before chemotherapy to measure levels of anti-mullerian hormone (AMH), follicle-stimulating hormone (FSH) and inhibin B. All are hormones related to ovarian function. Other medical information was also collected. The women kept calendars noting menstrual bleeding and had clinic visits every 6 months.

Results

The analysis was performed in 109 patients who stopped menstruating for at least 3 months. The medianinfo-icon age of these women was 39.5 years.

57 percent of these women had periods return after about 5.4 months. How long it took for periods to recover depended on the following:

  • younger age
  • AMH levels
  • FSH levels
  • weight

Menstruationinfo-icon return was not associated with levels of inhibin B, breast cancer stageinfo-icon or treatments, or medicineinfo-icon used for fertilityinfo-icon preservation.

While pre-chemotherapy levels of AMH and FSH were associated with the return of ovarian function, the researchers determined that AMH was especially important. They were able to estimate the time when menstrual bleeding would begin again by creating an individualized score based on a woman’s AMH level, age and body size.

Limitations

This study used menstrual bleeding as an indicationinfo-icon of ovarian function after chemotherapy. It might not mean fertility. The researchers said future studies are needed to validate their findings and to evaluate the relationship between return of ovarian function and fertility.

What This Means For You

You might not know if you want to try for pregnancy after breast cancer treatment, but talking with your doctor or a fertility specialist can help you understand your options.

This study shows it may be possible, before chemotherapy, to predict how quickly your ovaries will start functioning after chemotherapy. The scoring method developed in this study is still a research tool and is not yet used in standard clinicalinfo-icon practice.

Read our section on Fertility and Future Pregnancy to learn about treatment effects on fertility, how to plan ahead with fertility preservation and questions to ask your doctor.

Su, HI, Haunschild, C, Chung, K, et al. Prechemotherapy antimullerian hormone, age and body size predict timing of return of ovarian function in young breast cancer patientsCancer 2014; doi: 10.1002/cncr.28942.

This article was supported by the Grant or Cooperative Agreement Number 1 U58 DP005403, funded by the Centers for Disease Control and Preventioninfo-icon. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention or the Department of Health and Human Services.

Additional Related Topics 
Early-stage
Chemotherapy
Menopausal Symptoms