***TASK*** the task is to summarize an input biomedical literature in six sentences 
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    Input: PURPOSE Observational studies suggested that luteinizing hormone-releasing hormone agonists ( LHRHa ) might prevent premature ovarian failure result ing from adjuvant chemotherapy in premenopausal patients . We aim ed to test the efficacy of ovarian function preservation with the LHRHa goserelin in patients with breast cancer . PATIENTS AND METHODS In a prospect i ve , r and omized , open-label , controlled multicenter study , 60 patients younger than age 46 years with hormone-insensitive breast cancer were allocated to receive anthracycline/cyclophosphamide ( with or without taxane ) -based neoadjuvant chemotherapy with or without goserelin . The first goserelin injection was administered at least 2 weeks before the first chemotherapy cycle , continuing at 3.6 mg subcutaneously every 4 weeks until the end of the last cycle . The primary objective was the reappearance of normal ovarian function , defined as two consecutive menstrual periods within 21 to 35 days at 6 months after end of chemotherapy . RESULTS Fifty-three patients ( 88.3 % ) experienced temporary amenorrhea ( 93.3 % with v 83.3 % without goserelin ) . No significant difference was observed regarding the reappearance of menstruation at 6 months after chemotherapy ( 70.0 % with v 56.7 % without goserelin ; difference of 13.3 % ; 95 % CI , -10.85 to 37.45 ; P = .284 ) . All but one evaluable patient reported regular menses at 2 years after chemotherapy . Time to restoration of menstruation was 6.8 months ( 95 % CI , 5.2 to 8.4 ) with goserelin and 6.1 months ( 95 % CI , 5.3 to 6.8 ) without goserelin ( P = .304 ) . Chemotherapy result ed in a decreased ovarian reserve measured by inhibin B and anti-Müllerian hormone during follow-up , supporting the other findings . CONCLUSION Premenopausal patients with breast cancer receiving goserelin simultaneously with modern neoadjuvant chemotherapy did not experience statistically significantly less amenorrhea 6 months after end of chemotherapy compared with those receiving chemotherapy alone Background Chemotherapy-induced premature ovarian insufficiency ( POI ) impacts fertility and other aspects of women 's health . The OPTION trial tested whether administration of a gonadotropin-releasing hormone agonist during chemotherapy for early breast cancer reduced the risk of POI . Patients and methods This was a prospect i ve , r and omized , parallel group study of the gonadotropin-releasing hormone agonist goserelin administered before and during  chemotherapy  for breast cancer with stage I-IIIB disease . The primary outcome was amenorrhoea between 12 and 24 months after r and omization , supported by elevated follicle stimulating hormone concentrations to give an additional analysis as rate of POI . Results A total of 227 patients were r and omized and the primary analysis was conducted on 202 patients . Goserelin reduced the prevalence of amenorrhoea between 12 and 24 months to 22 % versus 38 % in the control group ( P = 0.015 ) and the prevalence of POI to 18.5 % versus 34.8 % in the control group ( P = 0.048 ) . Follicle stimulating hormone concentrations were also lower in all women treated with goserelin at both 12 and 24 months ( P = 0.027 , P = 0.001 , respectively ) . The effect of goserelin was not statistically significant in women > 40 years . Assessment of the ovarian reserve using anti-Müllerian hormone showed a marked fall in both groups during treatment to median values of 5 % of pretreatment levels in the control group and 7 % in the goserelin group , which were not significantly different between groups . Conclusion This study shows that goserelin reduced the risk of POI in women treated with chemotherapy for early breast cancer , with particular efficacy in women aged ≤40 years old . The degree of ovarian protection also seems limited and the clinical significance for fertility and longer term prevention of estrogen deficiency-related outcomes needs to be determined STUDY OBJECTIVE To explore the interindividual and intraindividual variation of Pictorial Blood Loss Assessment Chart ( PBAC ) registration s of subjective perception of minimal , normal , and heavy menstrual bleeding in women using their usual sanitary protection . DESIGN Retrospective study ( Canadian Task Force classification II-3 ) . SETTING University tertiary hospital . PATIENTS Women who had participated in 4 previously published prospect i ve studies using PBAC as the outcome measure . INTERVENTIONS Patients underwent hysteroscopic removal of polyps , laparoscopic occlusion of uterine vessels , or uterine artery embolization , and control subjects received no treatment . MEASUREMENTS AND MAIN RESULTS PBAC scores , hemoglobin concentration , and subjective assessment of periodic blood loss were recorded in 429 women during 1049 menstrual cycles . The median PBAC values in groups of women who assessed their bleeding as light , normal , and heavy were 45.0 , 116.0 , and 254.5 , respectively ( p < .001 ) . Sensitivity and specificity for specific PBAC cutoff points were calculated using a receiver operating characteristic curve . The maximum sensitivity for assessment of heavy periodic blood loss ( 78.5 ) was reached at a PBAC score of 160 . The corresponding specificity was 75.8 . At PBAC values below 130 , 90 % of the women reported normal blood loss , and 91 % had hemoglobin values > 12.0 g/dL. The reliability of repeated PBAC scores for individual measures was assessed via calculation of the intraclass correlation coefficient , which for repeated PBAC measurements was 0.86 ( 95 % confidence interval , 0.80 - 0.90 ) for average measures . CONCLUSION The interindividual variation was high , and the intraindividual variation was low . A low PBAC score may be used to define treatment end points for clinical use or in trials IMPORTANCE Whether the administration of luteinizing hormone-releasing hormone analogues ( LHRHa ) during chemotherapy is a reliable strategy to preserve ovarian function is controversial owing to both the lack of data on long-term ovarian function and pregnancies and the safety concerns about the potential negative interactions between endocrine therapy and chemotherapy . OBJECTIVE To evaluate long-term results of LHRHa-induced ovarian suppression during breast cancer chemotherapy . DESIGN , SETTING , AND PARTICIPANTS Parallel , r and omized , open-label , phase 3 superiority trial conducted at 16 Italian sites . Between October 2003 and January 2008 , 281 premenopausal women with stage I to III hormone receptor-positive or hormone receptor-negative breast cancer were enrolled . Last annual follow-up was June 3 , 2014 . INTERVENTIONS Patients were r and omized to receive adjuvant or neoadjuvant chemotherapy alone ( control group ) or chemotherapy plus triptorelin ( LHRHa group ) . MAIN OUTCOMES AND MEASURES The primary planned end point was incidence of chemotherapy-induced early menopause . Post hoc end points were long-term ovarian function ( evaluated by yearly assessment of menstrual activity and defined as resumed by the occurrence of at least 1 menstrual cycle ) , pregnancies , and disease-free survival ( DFS ) . RESULTS A total of 281 women ( median age , 39 [ range , 24 - 45 ] years ) were r and omized . Median follow-up was 7.3 years ( interquartile range , 6.3 - 8.2 years ) . The 5-year cumulative incidence estimate of menstrual resumption was 72.6 % ( 95 % CI , 65.7%-80.3 % ) among the 148 patients in the LHRHa group and 64.0 % ( 95 % CI , 56.2%-72.8 % ) among the 133 patients in the control group ( hazard ratio [ HR ] , 1.28 [ 95 % CI , 0.98 - 1.68 ] ; P = .07 ; age-adjusted HR , 1.48 [ 95 % CI , 1.12 - 1.95 ] ; P = .006 ) . Eight pregnancies ( 5-year cumulative incidence estimate of pregnancy , 2.1 % [ 95 % CI , 0.7%-6.3 % ] ) occurred in the LHRHa group and 3 ( 5-year cumulative incidence estimate of pregnancy , 1.6 % [ 95 % CI , 0.4%-6.2 % ] ) in the control group ( HR , 2.56 [ 95 % CI , 0.68 - 9.60 ] ; P = .14 ; age-adjusted HR , 2.40 [ 95 % CI , 0.62 - 9.22 ] ; P = .20 ) . Five-year DFS was 80.5 % ( 95 % CI , 73.1%-86.1 % ) in the LHRHa group and 83.7 % ( 95 % CI , 76.1%-89.1 % ) in the control group ( LHRHa vs control : HR , 1.17 [ 95 % CI , 0.72 - 1.92 ] ; P = .52 ) . CONCLUSIONS AND RELEVANCE Among premenopausal women with either hormone receptor-positive or hormone receptor-negative breast cancer , concurrent administration of triptorelin and chemotherapy , compared with chemotherapy alone , was associated with higher long-term probability of ovarian function recovery , without a statistically significant difference in pregnancy rate . There was no statistically significant difference in DFS for women assigned to triptorelin and those assigned to chemotherapy alone , although study power was limited . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00311636 OBJECTIVE To determine whether GnRHa administration before and during combination chemotherapy for breast cancer could preserve posttreatment ovarian function in young women or not . DESIGN Prospect i ve r and omized controlled study . SETTING Department of Obstetrics and Gynecology , Mansura University Hospital , Mansura , Egypt . PATIENT(S ) Eighty patients with unilateral adenocarcinoma of the breast and with no metastasis who had undergone modified radical mastectomy or breast-conserving surgery plus full axillary lymph node dissection were included in the study . Patients were assigned r and omly to receive combined GnRHa and chemotherapy or chemotherapy alone . One woman in each group dropped out . MAIN OUTCOME MEASURE(S ) Return of spontaneous menstruation and ovulation . Hormonal changes ( FSH , LH , E(2 ) , P ) during and after the course of treatment . RESULT ( S ) In the study group , 89.6 % resumed menses and 69.2 % resumed spontaneous ovulation within 3 - 8 months of termination of the GnRHa/chemotherapy cotreatment ; 11.4 % experienced hypergonadotrophic amenorrhoea and ovarian failure 8 months after treatment . In the control group ( chemotherapy without GnRHa ) , 33.3 % resumed menses and 25.6 % resumed normal ovarian activity . The median FSH and LH concentrations , 6 months after completion of the GnRHa/chemotherapy cotreatment group , were significantly less than the control group . During the GnRHa/chemotherapy cotreatment the concentrations of FSH , LH , and P decreased to almost prepubertal levels . However , within 1 - 3 months after the last GnRHa injection , an increase in LH and FSH concentrations was detected , followed several weeks later in by an increase in P concentrations to within normal levels . CONCLUSION ( S ) GnRHa administration before and during combination chemotherapy for breast cancer may preserve posttreatment ovarian function in women < 40 years . Long-term studies are required The increased survival of patients with breast cancer has given rise to other problems associated with the complications of chemotherapy . One major complication is premature ovarian failure , an especially harmful outcome for women of reproductive age . This study was performed to evaluate the efficacy of GnRH agonist ( GnRHa ) treatment on protecting ovarian function in young breast cancer patients ( 30.59±5.1 yr ) receiving chemotherapy after surgery . Twenty-two women were enrolled and given subcutaneous injections of leuprolide acetate ( 3.75 mg ) every 4 weeks during chemotherapy . Follow-up laboratory tests ( luteinizing hormone [ LH ] , follicle stimulating hormone [ FSH ] , and estradiol ) were performed 1 , 3 , and 6 months after  chemotherapy . Menstruation patterns and clinical symptoms were followed up for a mean duration of 35.6±1.7 months . FSH and LH levels were normal in all patients 6 months after completing chemotherapy ( 8.0±5.3 , 4.4±2.7 mIU/mL , respectively ) . During follow-up , none of the patients complained of menopausal symptoms and 81.8 % experienced recovery of menstruation . This report is the first trial of GnRHa as a treatment modality to protect ovarian function during adjuvant chemotherapy in young Korean breast cancer patients BACKGROUND The reduction of treatment-related toxic effects is the main goal in the current trials of 
    Output:
    
Evidence , albeit of low quality , supports the use of GnRHa before and /or during chemotherapy to reduce the risk of POI and increase the probability of spontaneous pregnancy in the short term .