Do estroprogestinic hormones protect against chemotherapy-induced amenorrhea in multiple sclerosis?

This commentary discusses a paper by Cocco et al. that addresses the treatment of multiple sclerosis (MS) with the drug mitoxantrone in women of childbearing age. This is a very important issue, as mitoxantrone is thought to be associated with the development of chemotherapy-induced amenorrhea (CIA) in women with MS. CIA is a condition characterized by cessation of menstrual bleeding that can be associated with either temporary or permanent infertility. In the study, a clear cumulative dose effect of mitoxantrone on the development of CIA was demonstrated. The risk of CIA was also shown to increase with age. However, the incidence of CIA was lower in women who took estroprogestinic hormones concurrently with mitoxantrone. The authors concluded that mitoxantrone may markedly affect reproductive capacity in women with MS and that estroprogestinic drugs should be administered alongside mitoxantrone to guard against these possible effects. The potential for estroprogestinic drugs to guard against CIA is intriguing and warrants further investigation.