Buijs Ciska, Willemse Pax H B, de Vries E G E, Ten Hoor Klase A, Boezen H M, Hollema Harry, Mourits Marian J E
Department of Medical Oncology, University Medical Center Groningen, University of Groningen, the Netherlands.
Int J Gynecol Cancer. 2009 May;19(4):677-81. doi: 10.1111/IGC.0b013e3181a47cbe.
Tamoxifen, a nonsteroidal antiestrogen, is the agent of choice in the treatment of premenopausal receptor-positive breast cancer. This study aimed to investigate the influence of tamoxifen on the menstrual cycle and serum hormone levels and the subsequent endometrial response in premenopausal breast cancer patients.
In tamoxifen-using breast cancer patients aged 55 years or younger, the last menstrual period was registered, serum hormone levels measured, and the endometrial response visualized by transvaginal ultrasonography every 6 months. Premenopausal status was defined as serum levels of estradiol (E2) 0.10 nmol/L or more and follicle-stimulating hormone 30 IU/L or less. Premenopausal patients with an endometrial response of greater than 12 mm were offered a hysteroscopy and curettage.
In 121 patients, a total of 241 measurements were performed. Amenorrhea predicted menopausal status incorrectly in 85 (35%) of the 241 measurements in 47 patients. In 8 of 47 endocrinologic premenopausal patients, transvaginal ultrasonography showed an endometrial response of greater than 12 mm (range,15-29 mm). Histopathology in women with an endometrial thickness of greater than 12 mm showed no malignancy. No relation between E2 levels and endometrial thickness was found.
Tamoxifen leads to a disconnection between clinical and endocrinologic menopause in breast cancer patients aged 55 years or less. In premenopausal patients, tamoxifen has a predominantly antiestrogenic effect on the endometrium without a correlation between E2 levels and endometrial response.
他莫昔芬是一种非甾体类抗雌激素药物，是绝经前激素受体阳性乳腺癌治疗的首选药物。本研究旨在探讨他莫昔芬对绝经前乳腺癌患者月经周期、血清激素水平及随后子宫内膜反应的影响。
在年龄55岁及以下使用他莫昔芬的乳腺癌患者中，记录末次月经时间，测量血清激素水平，并每6个月通过经阴道超声检查观察子宫内膜反应。绝经前状态定义为血清雌二醇（E2）水平≥0.10 nmol/L且促卵泡生成素水平≤30 IU/L。子宫内膜反应大于12 mm的绝经前患者接受宫腔镜检查和刮宫术。
121例患者共进行了241次测量。在47例患者的241次测量中，有85次（35%）闭经对绝经状态的预测错误。在47例内分泌学上处于绝经前的患者中，有8例经阴道超声检查显示子宫内膜反应大于12 mm（范围为15 - 29 mm）。子宫内膜厚度大于12 mm的女性组织病理学检查未发现恶性病变。未发现E2水平与子宫内膜厚度之间存在关联。
他莫昔芬导致55岁及以下乳腺癌患者临床绝经与内分泌学绝经脱节。在绝经前患者中，他莫昔芬对子宫内膜主要具有抗雌激素作用，且E2水平与子宫内膜反应之间无相关性。
