Phyto-progestins for the management of oligomenorrhea and/or endometrial thickening in reproductive-age breast cancer survivors with BRCA mutation: a retrospective, real-world study

The management of menstrual irregularities and/or endometrial thickening in reproductive-age breast cancer survivors (BCS) is debated, particularly during tamoxifen therapy, due to the impossibility of performing any hormonal screening. In this retrospective study, we evaluated the potential role of phyto-progestins, such as Dioscorea villosa (DV), Vitex agnus-castus (VAC), and Turnera diffusa (D) in this setting. We reviewed the clinical records of BCS of reproductive age with BRCA mutations who presented with oligo-amenorrhea and/or transvaginal ultrasound (TV-US)–detected endometrial thickening and were treated with phyto-progestins over the past five years. Patients were monitored every 6 months according to our surveillance program. The risk of BC recurrence was specifically assessed. We included a final group of 28 women (mean age: 44.0 ± 5.5 years). Of these, 57.1% presented with a baseline endometrial thickness > 10 mm. The treatment induced menstrual flow in all women except one (27/28, 96.4%) at a mean interval of 17.8 ± 2.4 days. At the subsequent TV-US check performed within 45 days of treatment, the endometrial thickness was < 5 mm in 100% of cases. The cyclical treatment was then used long-term, for a mean of 19.2 ± 15.5 months (mean satisfaction score: 7.8/10). After a mean follow-up of 42.2 ± 12.6 months, we recorded 3/28 (10.7%) loco-regional BC recurrences. A combination of DV, VAC, and D may represent a promising option for managing menstrual irregularities in BCS, with the potential for long-term use. The oncological safety of this treatment deserves further evaluation.