Iranian Society of Gynecology Oncology

Document Type : Original Research Article


1 Department of Obstetrics and Gynecology, Preventative Gynecology Research Center (PGRC), Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran

2 Resident of Anesthesiology, Velayat Medical Center, Qazvin University of Medical Sciences, Qazvin, Iran

3 Department of Obstetrics and Gynecology, Kerman University of Medical Sciences, Kerman, Iran.


Introduction: The administration of tamoxifen to post-menopausal patients with breast cancer may lead to vaginal bleeding, necessitating a thorough understanding of associated factors. Our objective was to investigate sonographic, hysteroscopic, and pathologic findings in breast cancer patients experiencing vaginal bleeding following tamoxifen use.
Methods: In this cross-sectional study, we evaluated women with post-menopausal breast cancer reporting vaginal bleeding while undergoing tamoxifen treatment for more than six months. Data collection involved a checklist encompassing ultrasonographic, hysteroscopic, and pathologic findings.
Results: The study included 100 patients with a mean age of 56.2 ± 2.9 years and a mean endometrial thickness of 14.5 ± 3.4 mm. Notably, 25% of the patients exhibited abnormally large uterine size. Ultrasonography revealed polyps and myomas in 36% and 15% of cases, respectively. Positive hysteroscopy findings were observed in 72%, comprising polyps in 36%, hyperplasia in 32%, and atrophy in 4%. Pathological assessment identified abnormal features in 31% as polyps, 34% as hyperplasia, 4% as atrophy, and 5% as cancerous lesions.
Conclusion:  Patients who received tamoxifen had high endometrial thickness due to endometrial polyp, it seems that clinicians can consider using hysteroscopy with dilation and curettage in these patients. 


Main Subjects

1. Yao J, Deng K, Huang J, Zeng R, Zuo J. Progress in the Understanding of the Mechanism of Tamoxifen Resistance in Breast Cancer. Front Pharmacol. 2020;11:592912. [DOI:10.3389/fphar.2020.592912] [PMID] [PMCID]
2. Shagufta, Ahmad I. Tamoxifen a pioneering drug: An update on the therapeutic potential of tamoxifen derivatives. Eur J Med Chem. 2018;143:515-31. [DOI:10.1016/j.ejmech.2017.11.056] [PMID]
3. Sarwar S, Alamro A, Huq F, Alghamdi A. Insights Into the Role of Epigenetic Factors Determining the Estrogen Response in Estrogen-Positive Ovarian Cancer and Prospects of Combining Epi-Drugs With Endocrine Therapy. Front Genet. 2022;13:812077. [DOI:10.3389/fgene.2022.812077] [PMID] [PMCID]
4. Fleming CA, Heneghan HM, O'Brien D, McCartan DP, McDermott EW, Prichard RS. Meta-analysis of the cumulative risk of endometrial malignancy and systematic review of endometrial surveillance in extended tamoxifen therapy. Br J Surg. 2018;105(9):1098-106. [DOI:10.1002/bjs.10899] [PMID]
5. Lee M, Piao J, Jeon MJ. Risk Factors Associated with Endometrial Pathology in Premenopausal Breast Cancer Patients Treated with Tamoxifen. Yonsei Med J. 2020;61(4):317-22. [DOI:10.3349/ymj.2020.61.4.317] [PMID] [PMCID]
6. Emons G, Mustea A, Tempfer C. Tamoxifen and Endometrial Cancer: A Janus-Headed Drug. Cancers. 2020;12(9):2535. [DOI:10.3390/cancers12092535] [PMID] [PMCID]
7. Eulo V, Lesmana H, Doyle LA, Nichols KE, Hirbe AC. Secondary Sarcomas: Biology, Presentation, and Clinical Care. Am Soc Clin Oncol Educ Book. 2020(40):463-74. [DOI:10.1200/EDBK_280985] [PMID]
8. Wang X, Wang S, Yao S, Shi W, Ma K. The clinical characteristics and treatment of ovarian malignant mesoderm mixed tumor: a systematic review. J Ovarian Res. 2022;15(1):104. [DOI:10.1186/s13048-022-01037-6] [PMID] [PMCID]
9. Wijayabahu AT, Egan KM, Yaghjyan L. Uterine cancer in breast cancer survivors: a systematic review. Breast Cancer Res Treat. 2020;180:1-19. [DOI:10.1007/s10549-019-05516-1] [PMID]
10. Sarioglu E, Vural F, Ertürk Coşkun AD. The relationship of endometrial pathologies with endometrial thickness and inflammatory markers in breast cancers using tamoxifen. Arch Gynecol Obstet. 2023;307(2):565-71. [DOI:10.1007/s00404-022-06608-y] [PMID]
11. Saccardi C, Gizzo S, Patrelli TS, Ancona E, Anis O, Di Gangi S, et al. Endometrial surveillance in tamoxifen users: role, timing and accuracy of hysteroscopic investigation: observational longitudinal cohort study. Endocr Relat Cancer. 2013;20(4):455-62. [DOI:10.1530/ERC-13-0020] [PMID]
12. Braithwaite RS, Chlebowski RT, Lau J, George S, Hess R, Col NF. Meta-analysis of vascular and neoplastic events associated with tamoxifen. J Gen Intern Med. 2003;18(11):937-47. [DOI:10.1046/j.1525-1497.2003.20724.x] [PMID] [PMCID]
13. L. E. Donne M, Alibrandi A, Ciancimino L, Azzerboni A, Chiofalo B, Triolo O. Endometrial pathology in breast cancer patients: Effect of different treatments on ultrasonographic, hysteroscopic and histological findings. Oncol Lett. 2013;5(4):1305-10. [DOI:10.3892/ol.2013.1156] [PMID] [PMCID]
14. Rosell J, Nordenskjöld B, Bengtsson NO, Fornander T, Hatschek T, Lindman H, et al. Long-term effects on the incidence of second primary cancers in a randomized trial of two and five years of adjuvant tamoxifen. Acta Oncol. 2017;56(4):614-7. [DOI:10.1080/0284186X.2016.1273547] [PMID]
15. Gerber B, Krause A, Müller H, Reimer T, Külz T, Makovitzky J, et al. Effects of adjuvant tamoxifen on the endometrium in postmenopausal women with breast cancer: a prospective long-term study using transvaginal ultrasound. J Clin Oncol. 2000;18(20):3464-70. [DOI:10.1200/JCO.2000.18.20.3464] [PMID]
16. Fung MF, Reid A, Faught W, Le T, Chenier C, Verma S, et al. Prospective longitudinal study of ultrasound screening for endometrial abnormalities in women with breast cancer receiving tamoxifen. Gynecol Oncol. 2003;91(1):154-9. [DOI:10.1016/S0090-8258(03)00441-4] [PMID]