Long-term effects of the levonorgestrel-releasing intrauterine system on serum lipids and the endometrium in breast cancer patients taking tamoxifen

Kesim, Melahat; Aydın, Yunus; Atis, Alev; Mandiraci, G

doi:10.1080/13697130802163168

Cited by 23 publications

(22 citation statements)

References 23 publications

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“…However, even endometrial protection against tamoxifen-stimulated endometrial changes by using LNG-IUS was demonstrated in several studies (Gardner et al 2000, Chan et al 2007, Kesim et al 2008). All in all, it can be concluded that LNG-IUS is a promising alternative to hysterectomy for the treatment of endometrial hyperplasia, although data are too sparse to recommend treatment of early endometrial cancer, and case reports are controversial (Parazzini et al 1994, Sturgeon et al 1997, Varila et al 2001, Giannopoulos et al 2004, Dhar et al 2005, Kresowik et al 2008.…”

Section: Risk Using Nonhormonal and Hormonal Intrauterine Devicesmentioning

confidence: 99%

Hormonal contraception and risk of endometrial cancer: a systematic review

Mueck¹,

Seeger²,

Rabe³

2010

Endocrine-Related Cancer

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More than 15 case-control studies and at least four large cohort studies demonstrated a decrease in the risk of endometrial cancer of about 50% for ever use of combined oral contraceptives (COCs). In most of these studies, this protective effect persisted for more than 10-15-20 years after cessation of the COC. An increasing protective effect with longer duration of COC use has been found in most studies. The beneficial effect was independent of the composition of COC, i.e. dosage and type of progestogen, combined with ethinyl estradiol 30-50 mg/day. COCs with higher progestogen potency seem to be somewhat more effective. Nonhormonal uterine devices have also been found to be strongly protective; however, data on oral or injectable progestogen-only preparations (POPs) including the levonorgestrel-releasing intrauterine system (LNG-IUS) are still rare, but also suggest similar protective action. COCs, POPs, as well as LNG-IUS can effectively reduce endometrial hyperplasia but should only be used in exceptional cases in patients with or after endometrial cancer. In contrast to nonhormonal IUS, systemic side effects cannot be excluded with LNG-IUS, but they are certainly rare, as the main effect has decreased the endometrial estrogen response because of the high endometrial tissue levels of LNG.

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Section: Risk Using Nonhormonal and Hormonal Intrauterine Devicesmentioning

confidence: 99%

Hormonal contraception and risk of endometrial cancer: a systematic review

Mueck¹,

Seeger²,

Rabe³

2010

Endocrine-Related Cancer

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show abstract

“…This has led to suggested therapeutic regimes that can be introduced alongside endocrine therapy to manage specific side effects for tamoxifen or aromatase inhibitors [58][59][60][61][62][63]. This includes amelioration of the osteopenic (e.g., calcium, vitamin D and exercise) or osteoporotic (i.e., bisphosphonates) effects of aromatase inhibitors.…”

Section: Side Effectsmentioning

confidence: 98%

The Importance of Nonpharmacogenetic Factors in Endocrine Therapy

McCowan

Thompson

2012

Pharmacogenomics

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Nonpharmacogenetic factors may play a key role in the success of oral endocrine therapy for breast cancer. Adherence, defined as following medical advice as well as persistence and duration of use for patients prescribed endocrine therapy, may impact significantly on recurrence and survival. Side effects from tamoxifen or aromatase inhibitors may lead to patients stopping or switching therapy, while comorbidities, consequent coprescribing and patient perceptions may also influence outcomes. Interventions to improve adherence and persistence are required and could have as great an effect on survival as applying pharmacogenetic principles to the endocrine management of breast cancer.

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“…Moreover, Kesim et al (2008) and Trinh et al (2008) found out that LNG-IUS significantly prevent the increased risk of endometrial polyps and hyperplasia associated with the use of tamoxifen in women with breast cancer and this reduce patient discomfort while improving treatment adherence. Qi et al (2008) reported that two infertile patients presented with complex atypical EH became pregnant following conservative treatment with LNG-IUS insertion, and histological morphology of endometrial samples after 6 months' exposure to LNG-IUS showed secretory or atrophic glands with decidualized stroma.…”

Section: Discussionmentioning

confidence: 99%

Levonorgestrel-releasing intrauterine device for management of tamoxifen-induced menorrhagia in breast cancer patients

Elnory¹,

El-Habbaa²,

Rageh³

2014

J. Cancer Res. Exp. Oncol.

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This study aimed to evaluate the therapeutic yield of levonorgestrel-releasing intrauterine device (LNG-IUD) for management of tamoxifen induced menorrhagia in women who had mastectomy for treatment of breast cancer. This study included 34 patients who had breast cancer, underwent mastectomy, were maintained on tamoxifen post-operatively for at least 6 months, and had also newly developed menorrhagia throughout their follow-up period. All the patients underwent clinical examination for determination of duration and heaviness of menstrual blood loss (MBL), transvaginal ultrasonography (TVU) and endometrial biopsy for exclusion of abnormal pathology, estimation of blood iron indices and quality of life (QoL) scoring. Baseline endometrial biopsy detected simple endometrial hyperplasia (EH) in 4 patients and 30 patients had proliferative endometrium. Three patients were excluded and 31 patients completed the follow-up period without the need for shift to hysterectomy. Both mean duration and heaviness of MBL showed significant progressive decrease throughout the observation period as compared to baseline data. At the end of follow-up period, 5 women became amenorrheic, 2 women had moderate MBL and 24 women had mild MBL. Iron indices studies showed significant improvement at the end of follow-up as compared to baseline indices and total QoL scoring recorded at 6 and 12 months after enrollment were significantly higher as compared to baseline scores with significantly higher scores at 12 months. LNG-IUD could be considered as an appropriate therapeutic modality for tamoxifen-induced menorrhagia in patients who had mastectomy for breast cancer with significant reduction of duration and severity of MBL and improved QoL and iron indices.

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Long-term effects of the levonorgestrel-releasing intrauterine system on serum lipids and the endometrium in breast cancer patients taking tamoxifen

Cited by 23 publications

References 23 publications

Hormonal contraception and risk of endometrial cancer: a systematic review

Hormonal contraception and risk of endometrial cancer: a systematic review

The Importance of Nonpharmacogenetic Factors in Endocrine Therapy

Levonorgestrel-releasing intrauterine device for management of tamoxifen-induced menorrhagia in breast cancer patients

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