Acting on the pituitary, LHRH-a initially stimulate FSH and LH secretion, then profoundly suppress the pituitary ovarian axis, resulting in a fall in serum estrogen to menopausal levels Although no initial rise in serum estrogen has been detected in women with advanced breast cancer treated with LHRH-a, breast cancer flare reactions may occur in some patients, and have been attributed to gonadotropin release.
tamoxifen hot flashes Key NICE recommendations are summarised in Table 1.