Original PaperChemotherapy for gestational trophoblastic tumours hastens menopause by 3 years
Introduction
There are an increasing number of women surviving long term following curative cytotoxic chemotherapy and gonadal function in these women has become a focus of concern. Many studies have focused on ovarian failure, pregnancy and risk to offspring following chemotherapy. Most women who are successfully treated with combination chemotherapy before the age of 25 years retain their normal ovarian function1, 2, 3, 4, 5. Although there have been reports of women whose menses returned after chemotherapy subsequently developing amenorrhoea, it remains unknown whether women who receive chemotherapy are at risk of an early menopause.
A large cohort of women have been treated with chemotherapy for gestational trophoblastic disease in our unit and remain in contact through monitoring assays for human chorionic gonadotrophin (hCG). A control group of women were recruited who were registered for hCG follow-up following the diagnosis of hydatidiform molar pregnancy, but who had not required chemotherapy for persistent trophoblastic disease. We undertook a postal questionnaire survey of these women enquiring about the age of menopause.
Section snippets
Patients and methods
Between 1958 and 1990, 1,377 women were treated with cytotoxic chemotherapy for gestational trophoblastic disease in our unit. Questionnaires were sent to 1,089 women known to be long-term survivors still resident in the U.K. who were on hCG monitoring follow-up. The questions were designed to detect the date of menopause and the occurrence of second malignancies and have been presented elsewhere[6]. Women were asked about their health, hospital admissions and obstetric history since they
Results
Questions regarding menopause were completed by 972 women treated with for GTT, representing 89% of questionnaires sent. Responses were obtained from 327 women in the control arm (82% of questionnaires sent). For 124 women it was not possible to evaluate the date of menopause as the women had either undergone a hysterectomy as part of their treatment for GTT or had developed permanent amenorrhoea whilst receiving chemotherapy for GTT. 42 of these women received hormone replacement therapy,
Discussion
Pretreatment fertility in men with testicular tumours and Hodgkin’s disease is impaired[13], but pretreatment amenorrhoea is uncommon in women with Hodgkin’s disease[14]. None the less, it has been suggested that premenopausal women with breast cancer are more frequently having anovulatory cycles[15]and this suggests that these women are subfertile prior to therapy. In contrast, all women with GTT who make up this cohort are fertile by definition prior to treatment.
Cytotoxic drugs disrupt
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