Clinical consideration of two key questions in assessing menopausal status of female breast cancer patients

Endocrine therapy plays a crucial role in hormone receptor-positive breast cancer and is closely related to the patient’s menopausal status. This manuscript aimed to explore two key questions in assessing menopausal status of breast cancer patients. Firstly, for premenopausal patients receiving ovarian function suppression (OFS) therapy, persistently elevated estradiol (E2) levels post-treatment may be attributed to either “true” or “pseudo” elevation, with caution needed due to potential interference from endocrine therapy drugs such as fulvestrant, abemaciclib, exemestane and tamoxifen. Secondly, when determining whether patients under OFS therapy have reached physiological menopause, factors such as the impact of chemotherapy on menopausal status and the complexity of hormone levels around menopause need to be considered. It is recommended to consider switching treatments based on the patient’s age and original endocrine therapy, and to regularly monitor levels of estradiol and follicle-stimulating hormone (FSH). In challenging cases, a comprehensive evaluation can be conducted by incorporating markers such as anti-Mullerian hormone (AMH), inhibin B (INHB) and androgen.