Hysteroscopic Imaging of Health Endometrium in Premenopausal Breast Cancer Patients Taking Anti-estrogen Therapies

Purpose: To assess the physiological response of endometrium to different anti-estrogenic treatments in premenopausal breast-cancer patients, based on hysteroscopy imaging and endometrial biopsy. Methods: We reviewed the hysteroscopic findings of 26 patients suffering from breast cancer currently taking anti-estrogenic treatments and in whom an endometrial biopsy yielded a diagnosis of functional conditions. Fourteen patients were treated by Tamoxifen (Tam), 8 with Tam and Gonadotropin-Releasing Hormone (Gn-RH) analogues, 1 with Tam and Gn-RH analogue plus Megestrole acetate and 3 with Exemestane and Gn-RH analogue. Hysteroscopic findings were related to each scheduled treatment. Results: Proliferative, secretory and hyperplastic endometrial features have been found in all patients taking Tam. The addition of Gn-RH analogue to Tam led invariably to atrophic endometrial imaging, exhibiting gland cyst differentiation in half of the cases. A progestogen agent addition, such as Megestrole acetate to this latter schedule induced endometrial hyperplastic-like appearances sustained by stromal decidualization. In patients undergoing Exemestane and Gn-RH analogue association we found inactive endometrium and proliferative features in two and one case, respectively. Conclusion: In premenopausal patients, the anti-estrogenic drug schedule to treat estrogen-receptor positive breast cancer leads to different but quite predictable molding effects on endometrium. Due to the frequent need for gynecological consultation and endometrial assessment in this group of women, hysteroscopy practitioners should gain awareness about the expected iatrogenic effects of anti-estrogens on endometrial lining.