Abnormal uterine bleeding and uterine pathology in women on tamoxifen therapy
- Steven R Goldstein, MD
Steven R Goldstein, MD
- Professor of Obstetrics and Gynecology
- New York University School of Medicine
- Jamie N Bakkum-Gamez, MD
Jamie N Bakkum-Gamez, MD
- Associate Professor of Obstetrics and Gynecology
- Mayo Clinic, Rochester, Minnesota
- Section Editors
- Robert L Barbieri, MD
Robert L Barbieri, MD
- Editor-in-Chief — Obstetrics, Gynecology and Women's Health
- Section Editor — General Gynecology and Female Reproductive Endocrinology
- Kate Macy Ladd Professor of Obstetrics, Gynecology and Reproductive Biology
- Harvard Medical School
- Barbara Goff, MD
Barbara Goff, MD
- Section Editor — Gynecologic Oncology
- Professor of Gynecologic Oncology
- University of Washington
- Harold Burstein, MD, PhD
Harold Burstein, MD, PhD
- Section Editor — Breast Cancer
- Associate Professor of Medicine
- Harvard Medical School
Tamoxifen is a nonsteroidal selective estrogen receptor modulator that is used primarily for adjuvant treatment of estrogen receptor-positive breast cancer in premenopausal women, and in some postmenopausal women . It is also used for chemoprevention in women at increased risk for breast cancer.
Tamoxifen is associated with increased risks of uterine pathology, including endometrial polyps, endometrial carcinoma and hyperplasia, uterine sarcoma, and uterine carcinosarcoma.
Uterine pathology in women on tamoxifen is reviewed here. Use of tamoxifen for breast cancer therapy or breast cancer prevention and management of other adverse effects associated with tamoxifen are reviewed separately. (See "Adjuvant endocrine therapy for non-metastatic, hormone receptor-positive breast cancer" and "Selective estrogen receptor modulators and aromatase inhibitors for breast cancer prevention" and "Managing the side effects of tamoxifen".)
Mechanism of action — Tamoxifen is a competitive inhibitor of estrogen, binding to the estrogen receptor in the breast, which blocks tumor proliferation [2,3]. However, tamoxifen has a complex mechanism of action against tissues. While it is anti-estrogenic in the breast, it can be either an estrogen antagonist or agonist at different sites of the female reproductive tract.
Endometrial and menstrual effects — Tamoxifen is a mixed estrogen antagonist and agonist (referred to as a selective estrogen receptor modulator [SERM]).To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- Mechanism of action
- Endometrial and menstrual effects
- - Premenopausal women
- - Postmenopausal women
- CLINICAL PRESENTATION AND EVALUATION
- Abnormal uterine bleeding
- - Evaluation
- Medical history
- Determining menopausal status
- Pelvic ultrasound and endometrial sampling
- Incidental findings on pelvic ultrasound
- RISKS AND MANAGEMENT OF UTERINE PATHOLOGY
- Endometrial polyps
- Endometrial hyperplasia
- Endometrial carcinoma
- - Risk of malignancy
- Postmenopasual versus premenopausal women
- Duration of therapy
- Risk after discontinuation of tamoxifen
- - Management
- - Prognosis
- - Screening
- Uterine sarcoma and carcinosarcoma
- MANAGEMENT ISSUES
- Persistent AUB without uterine pathology
- Progestins for prevention and treatment
- SUMMARY AND RECOMMENDATIONS