How childhood cancer and its treatment effects female reproductive function depends on many factors including your age at treatment, the type and location of cancer, and the treatment you received. Here’s what you need to know to figure out if you are at risk for reproductive problems.
Am I at Risk?
The following treatments can damage the ovaries, putting you at risk for reproductive problems:
- radiation to the stomach area, pelvis, lower spine, head or brain, or whole body;
- certain chemotherapy drugs, including those in a class called alkylators (such as busulfan, carmustine, and ifosfamide) and heavy metals; and
- removal of one or both ovaries.
What Reproductive Problems Can Occur?
The following reproductive problems can occur in females.
Ovarian Failure
When the ovaries don’t produce eggs or hormones it is called ovarian failure. A number of health problems can result, including:
- Failure to enter puberty – Girls who received chemotherapy that caused ovarian failure before puberty will need to take hormones to enter and progress through puberty.
- Early menopause – Some women who had monthly periods before cancer treatment don’t resume them after treatment and enter menopause early.
- Lack of estrogen – Females with ovarian failure don’t make enough estrogen, which is important for reproduction, strong bones, a healthy heart, and overall well-being.
- Infertility – Females with ovarian failure cannot become pregnant.
- Most females with ovarian failure should see a doctor who specializes in hormones (endocrinologist) for hormone replacement therapy until middle age.
Short-term Stop in Menstrual Cycles
Many females will stop having monthly periods during cancer treatment. In most cases, menstrual cycles will start again sometime after treatment ends. But the timing of this varies and can take up to a few years.
Early Menopause
Some women who resume having monthly periods after cancer treatment are at risk for starting menopause early. This includes females who received chemotherapy or radiation that can affect ovarian function and those who had one ovary removed. Women at risk for early menopause who want to have children should try to do so before their mid-thirties. This is because the time during which they can have children may be shorter.
Infertility
Infertility is when you are not able to become pregnant after at least one year of unprotected sex. Women who don’t have monthly periods, who have them only by taking hormones, or who had to take hormones to enter or progress through puberty are likely to be infertile. Survivors who had both ovaries removed also will be infertile. Those who had their uterus removed, but still have ovaries that function can become mothers by having another female carry the pregnancy to term.
Women who are infertile should discuss their options with a fertility specialist and their oncologist. Options include using donor eggs, adopting, or living childfree.
Pregnancy Risks
Women who had radiation to the whole stomach area, pelvis, lower spine, or whole body may have a higher risk for miscarriage, preterm delivery, or problems during labor. In addition, women who received anthracycline chemotherapy or radiation to the upper stomach area or chest may be at risk for heart problems that can worsen during pregnancy (see related Health Link: “Heart Health after Childhood Cancer“).
Women who are at risk for problems during pregnancy should be followed closely be an obstetrician with experience with high-risk pregnancies.
In most cases, risk for cancer and birth defects are not higher in children born to childhood cancer survivors. In rare cases, risk might be higher for cancers that are hereditary. Ask your oncologist if you don’t know if your cancer was genetic.
Should I Be Checked for Reproductive Problems?
All childhood cancer survivors should have a long-term follow-up visit every year. If you are at risk for reproductive problems your check-up should include careful evaluation of your progress through puberty, menstrual and pregnancy history, and sexual function.
Your doctor might order a blood test to check your hormone levels. If any problems are found, you may be referred to an endocrinologist or other specialist. Women with ovarian failure may also have a special type of X-ray to check for thinning of the bones (osteoporosis).