▸ Prior bilateral oophorectomy.
▸ Age 60 years or older.
▸ Age younger than 60 years and amenorrheic for at least 12 months in the absence of chemotherapy, tamoxifen, toremifene, or ovarian suppression, and FSH and estradiol in the postmenopausal range.
▸ Age younger than 60 years and FSH and plasma estradiol level in postmenopausal range in women taking tamoxifen or toremifene.
It is not possible to assign menopausal status to women receiving an LHRH agonist or antagonist, the guidelines state. Amenorrhea is not a reliable indicator of menopausal status in women who are premenopausal at the outset of adjuvant chemotherapy.
“Women who undergo chemotherapy treatments that permanently stop menses may still produce estradiol at levels that are premenopausal,” said Dr. Carlson, stressing that premenopausal estrogen levels can influence treatment with aromatase inhibitors.