Ovarian recovery after total body irradiation and allogeneic bone marrow transplantation: long-term follow up of 79 females.
Seventy-nine females undergoing allogeneic BMT following conditioning with total body irradiation (TBI), were prospectively followed between March 1983 and March 1992 with regular gynaecological examinations, including plasma levels of luteinising hormone (LH), follicle stimulating hormone (FSH), 17-beta oestradiol (E2) and pelvic ultrasonography. The end-points of this study were the following: (1) early and late effects of TBI on ovarian function, (2) compliance and results of hormonal replacement therapy (HRT), and (3) predictive events for ovarian recovery. During the first year post-BMT most adult women complained of vasomotor and/or genitourinary tract symptoms. These were associated with decreased E2 and increased LH-FSH plasma levels and a deterioration in their sexual life (94% of sexually active women). Forty-nine adult females were selected to receive systemic hormonal replacement therapy (HRT), consisting of cyclic transdermal oestrogens plus medroxyprogesterone acetate (MPA) or cyclic oral therapy with low doses of conjugated oestrogens and MPA: these patients were selected on the basis of age (< 45 years), absence of medical contraindications or subjective refusal. Compliance and tolerability were overall good: most women (65%) never stopped HRT; this was discontinued in 14 patients for medical reasons and in 3 because of refusal. Forty-three females completed 6 months of HRT: vasomotor symptoms disappeared in 91% of 58 women who previously referred these symptoms. Improvement of genitourinary symptoms was seen both with local and systemic hormonal therapy. However sexual symptoms were reduced in 21 of 26 women (81%) given HRT compared with 8 of 19 (42%) women given local treatment (p = 0.02).(ABSTRACT TRUNCATED AT 250 WORDS)
Spinelli
S
S
Divisione di Ematologia, S. Martino Hospital, Genova, Italy.
Chiodi
S
S
Bacigalupo
A
A
Brasca
A
A
Menada
M V
MV
Petti
A R
AR
Ravera
G
G
Gualandi
F
F
VanLint
M T
MT
Sessarego
M
M
D000293:Adolescent; D000328:Adult; D016026:Bone Marrow Transplantation; D002648:Child; D015914:Estrogen Replacement Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008572:Menarche / Q000187:drug effects / Q000528:radiation effects; D008598:Menstruation / Q000187:drug effects / Q000528:radiation effects; D010053:Ovary / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000528:radiation effects; D011247:Pregnancy; D016649:Primary Ovarian Insufficiency / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology*; D011446:Prospective Studies; D014463:Ultrasonography; D014916:Whole-Body Irradiation / Q000009:adverse effects*