Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0002453 (amenorrhea)
 6,245 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The prognostic role of drug-induced amenorrhea (DIA) was restrospectively evaluated in 221 out of 254 consecutive premenopausal patients treated with adjuvant CMF or a CMF-containing regimen; 33 patients were eliminated because of lack of menstrual data. All patients had metastatic axillary nodes; drug regimens were: CMF x 9 courses +/- Tamoxifen (TM) and CMF x 6 courses; median age was 43 (range 26-54). Premenopausal status was defined as last normal menses within the 6 weeks preceding initiation of chemotherapy: DIA as cessation of menses for at least 3 months not later than 3 months from the end of chemotherapy. DIA occurred in 166,221 (75.1%) patients and was strictly related to the age of the patients; also, the older the patients the shorter the time required to develop DIA. At median follow up of 69 months, Mantel-Byar analysis showed a longer disease free survival (DFS) for patients who developed DIA as compared with non amenorrheic women (P less than 0.001). DIA prognostic value was independent of age, number of involved nodes, tumour size and number of CMF cycles, as assessed by the Cox model (RH 0.43, 95% C.I. 0.24-0.77), in which DIA was entered as a time dependent covariate.
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PMID:Prognostic role of amenorrhea induced by adjuvant chemotherapy in premenopausal patients with early breast cancer. 203 6

There are many methods that can be used to induce ovulation when there is a fault in ovulation in patients who have normal prolactin levels. These are: Bringing the weight to a normal level. Giving Clomiphene. Giving Tamoxifen. Giving cyclofenil and bromocriptine, which really have no more effect than giving a placebo. Giving gonadotrophins in a classical way. This is very useful where there is hypogonadic amenorrhoea but much less useful when the failure of ovulation occurs with normal gonadic function. It is accompanied by a risk of multiple pregnancies and of hyperstimulation, which should be monitored by ultrasound very strictly so that it cannot become too serious. The use of purified FSH which theoretically should be more adequate, at least in cases where the gonadic function is normal in spite of failure of ovulation. Pulsatile administration of LHRH, which in cases of hypothalamic amenorrhoea carries less total risk than giving gonadotrophins. Finally, wedge resection of the ovaries which is reversed for polycystic ovaries that are larger than normal in size, and allied methods. The first choice for hypogonadic hypothalamic amenorrhoea would seem to be the LHRH pump; and for failure of ovulation with normal gonadic function Clomiphene or Tamoxifen. When anti-oestrogens fail to correct these latter cases one can choose according to the case between gonadotrophins, choosing if possible pure FSH, and/or wedge resection. In the last resort in these cases the LHRH pump can be used. The frequent failure of these methods show that perhaps it is possible to create a hypogonadotrophic hypogonadism by giving agonists for a long time or antagonists to LHRH in such a way that a second attempt can be made to induce ovulation using gonadotrophins in better conditions of efficacy and safety.
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PMID:[Induction of ovulation in 1985]. 393 50

Tamoxifen (Norvadex), synthesized by the Imperial Chemical Industries Ltd., is a triphenylethylene derivative having a clomiphene-like structure and displays anti-estrogenic activities. In this study we used tamoxifen for the treatment of anovulatory infertility and investigated the clinical results. Induction rate of ovulation recorded 100% in the patients with sporadic anovulatory cycle, 83.3% in those with persistent anovulatory cycle, 70% in those with the first grade amenorrhea type I and 66.7% in those with the first grade amenorrhea type II. However, tamoxifen was absolutely ineffective against the second grade amenorrhea. The patients with sporadic or persistent anovulatory cycle responded to 40 mg-daily tamoxifen-treatment, recording 100% of ovulatory induction rate. The patients with the first grade amenorrhea also responded to 60 mg-daily treatment, indicating 70% of ovulatory induction rate. The rate of pregnancy established in the women desiring pregnancy marked 15.4%, and 2 out of 4 women with successful pregnancy experienced spontaneous abortion. Out of 4 patients who did not respond to the previous clomiphene treatment, 3 women accomplished ovulatory induction with tamoxifen. The endocrinological dynamics in the tamoxifen treatment were similar to those in the clomiphene treatment.
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PMID:Induction of ovulation with an estrogen antagonist, tamoxifen. 643 32

Tamoxifen (T) was given in doses of 40-120 mg/day to 11 premenopausal women with stage IV breast cancer. Objective remission occurred in five, the disease did not progress in one, and five failed to respond. Duration of remission is 19+ months. Five patients underwent ovariectomy after receiving T: of two who responded to T and then relapsed, one responded to ovariectomy; three who failed to benefit from T also failed to improve after ovariectomy. The effect of T on the menstrual cycle ranged from no effect to complete cessation of menses, usually observed in patients who received larger doses. T induced a marked rise in serum estrone and estradiol, reaching levels up to 2500 pg/ml; serum follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels remained in the normal premenopausal range or were slightly elevated. In two patients in whom amenorrhea was induced with larger doses of T, both serum estrogen and gonadotropin levels were elevated. We conclude that T is effective in treating premenopausal patients with stage IV breast cancer. Because of the stimulating effect of T on ovarian function. escalated doses of T or castration plus T may be necessary in those patients who respond to T.
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PMID:Antiestrogen-induced remissions in premenopausal women with stage IV breast cancer: effects on ovarian function. 677 8

Tamoxifen is reported to increase the risk of endometrial cancers mostly in postmenopausal women. In the Royal Marsden chemoprevention programme, we noted that premenopausal women at the start of tamoxifen/placebo who developed amenorrhea may be at special risk of endometrial cancer. The aim of this report was to investigate recently amenorrheic women by measuring plasma estradiol (E2), follicular stimulating hormone (FSH), and endometrial thickness (ET) by transvaginal ultrasound (TVUS). ET readings and E2 levels were available in the same proportion of women on tamoxifen or placebo. Women on placebo developed amenorrhea with upper limit of E2 readings of 450 pmol/L. In both postmenopausal women and recently amenorrheic women with low E2 (< or = 450 pmol/L), tamoxifen significantly increased endometrial thickening (p < 0.0001 and < 0.005 respectively). Conversely, tamoxifen did not result in endometrial thickening in women with high E2 (> 450 pmol/L), with a trend to lower ET readings (p = 0.07). Finally, all five women who developed endometrial cancer were premenopausal at the start of tamoxifen/placebo. Two of these five women were asymptomatic with increased ET readings (17 mm and 17 mm) and low E2 levels (32 and 51 pmol/L). These results indicate that women who develop amenorrhea on tamoxifen may be at special risk of endometrial cancer. Tamoxifen causes endometrial thickening in amenorrheic women with low E2 but has an opposite antiestrogenic effect in women with high E2. We recommend that women who develop amenorrhea on tamoxifen especially in the presence of endometrial thickening, low E2 levels, and/or gynaecological symptoms warrant further investigations.
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PMID:Variation in endometrial thickening in women with amenorrhea on tamoxifen. 954 Nov 92

Tamoxifen is a nonsteroidal anti-oestrogen with gynaecological side-effects. Only recently, ovarian cyst formation during tamoxifen treatment has been reported. The present study aimed to evaluate patient-related parameters that determine ovarian cyst formation in women using tamoxifen for breast cancer. A cross-sectional study was performed in 142 breast cancer patients using tamoxifen. Forty-five patients were also examined prior to tamoxifen treatment. Gynaecological assessment, transvaginal ultrasonography (TVU) and serum oestradiol (E2) and follicle stimulating hormone (FSH) analysis were performed. Follow-up assessments were performed twice a year. Uni- or bilateral ovarian cysts were detected by TVU in 24 tamoxifen-using patients and in one patient before tamoxifen treatment. Multiple regression analysis showed that cyst development is related (multiple R = 0.73) to high E2 (P < 0.001), younger age (P < 0.001) and absence of high-dose chemotherapy (P = 0.007). Patients with ovarian cysts had higher serum E2 levels compared to patients without cysts (1.95 vs 0.05 nmol l(-1); P < 0.001). All patients after high-dose chemotherapy or older than 50 years had E2 < 0.10 nmol l(-1) and/or amenorrhoea > 1 year and did not develop ovarian cysts. Patients still having a menstrual cycle during tamoxifen had a high chance (81%) of developing ovarian cysts. Breast cancer patients receiving tamoxifen only develop ovarian cysts if their ovaries are able to respond to FSH stimulation as shown by E2 production.
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PMID:Ovarian cysts in women receiving tamoxifen for breast cancer. 1020 89

Comparisons between the effects exerted by adjuvant cyclophosphamide, methotrexate and 5-fluorouracil (CMF)-based polychemotherapy and endocrine treatment in premenopausal breast cancer patients are validly drawn in the presence of steroid hormone receptor responsiveness. First, ovarian ablation still remains to show activity compared with chemotherapy in large patient groups. Second, tamoxifen is at least as active in this cohort and, by comparison, produces a significant effect in mortality reduction. Third, induction of reversible amenorrhoea by LHRH analogue administration has shown comparable effects in terms of recurrence-free survival. Finally, recent European investigations have indicated significant recurrence reductions with LHRH analogue-tamoxifen combination strategies. In conclusion, various endocrine treatment modalities have been substantiated as equiefficient to polychemotherapy. Tamoxifen added to a LHRH analogue further diminishes the recurrence rates and now appears to be a valid treatment alternative. We argue that selection of adjuvant systemic therapy for premenopausal breast cancer patients be increasingly guided by knowledge of the steroid hormone receptor levels.
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PMID:Chemotherapy versus hormonal adjuvant treatment in premenopausal patients with breast cancer. 1181 96

Clomiphene, Tamoxifen and Epimesterol were used to determine the proper selection of the best parameter of ovulation detection in the absence of pregnancy. The trial consisted of 65 anovular infertile Egyptian women, ranging from 18-35 years of age, with at least 1 year of infertility, with different menstrual patterns varying from amenorrhea, oligohypomenorrhea to anovular menstruation. 6 parameters of ovulation detection were used: 1) basal body temperatures; 2) endometrial biopsy; 3) serial vaginal smears; 4) cervical mucus changes; 5) LH assay in morning urine; and 6) plasma progesterone by C.P.B. Clomiphene was tried on 25 patients as was Tamoxifen. Epimesterol was tried on 15 patients. The patients received the drugs for 174 courses. 41 had ovulation in 77 courses; 14 patients got pregnant; 4 of them aborted. It was occasionally difficult to decide on the basis of 1 test alone, whether a patient ovulated in a particular cycle because of the anti-estrogenic effect observed particularly with Tamoxifen and Clomiphene, but not with Epimesterol. The best parameter of ovulation detection in non-pregnant cases was hormonal assay. Due to the requirement of special equipment for such assay, endometrial biopsy at the onset of menstruation done parallel with BBT to avoid induction of abortion in early undiagnosed threatened abortion could be considered a fairly good parameter of ovulation detection.
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PMID:Selection of best parameters for ovulation detection in induction of ovulation with organic non-steroidal synthetic compounds. 1226 21

Breast cancer is rare before age 40. Sixty to seventy percent of breast cancers in this age group express estrogen or progesterone receptors. All following considerations refer to endocrine responsive disease. Ovarian ablation reduces the relative risk of recurrence and death by at least one quarter in the absence of chemotherapy. Chemotherapy induced amenorrhea reduces the risk of recurrence and death when compared to patients with continuing menses. Chemotherapy is insufficient therapy for very young patients with hormone responsive disease, particularly if chemotherapy fails to induce amenorrhea. Tamoxifen is effective in young patients even in combination with chemotherapy. The ablation or suppression of ovarian function was equivalent to chemotherapy in at least eight randomized trials. Preliminary evidence is compatible with an additional adjuvant effect of LHRH agonists after chemotherapy, particularly in women < 40 years of age. Young patients with endocrine responsive tumors should be treated on a clinical trial. If this is impossible, they should receive tamoxifen and either an LHRH agonist or chemotherapy or both.
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PMID:Adjuvant endocrine therapy for the very young patients. 1465 28

Tamoxifen has both agonistic and antagonistic effects on the female genital tract, depending on the ambient oestradiol concentration and the menopausal status of the patient. In postmenopausal women tamoxifen has an oestrogen agonistic effect on the vaginal epithelium, the uterine myometrium and the endometrium. It may induce benign cystic hyperplasia of the endometrial stroma and cause an increase in poly formation. The risk of endometrial cancer increases 2-3-fold after an exposure of up to 5 years. In asymptomatic tamoxifen users, gynaecological surveillance is not recommended. However, if there is postmenopausal bleeding, then transvaginal ultrasonography and histology of the endometrium are indicated. Tamoxifen can aggravate hot flushes and have a negative effect on sexual function. In premenopausal women, tamoxifen may induce ovarian cysts resulting in high serum-oestradiol levels. Oligomenorrhoea and amenorrhoea will occur in half of the patients. Tamoxifen has an antagonistic effect on the endometrium in premenopausal women and is associated with hot flushes and impaired sexual functioning. Teratogenic effects on the foetus have been described. Despite its gynaecological side effects, the benefits of tamoxifen in breast-cancer treatment outweigh the risks. Patients need to be informed about these side effects. Irregular or postmenopausal blood loss must always be reported to the treating physician.
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PMID:[The effects of tamoxifen on the female genital tract]. 1466 36


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