Hormonal replacement therapy after stem cell transplantation.
OBJECTIVE
To evaluate HRT compliance and efficacy in the treatment of symptomatic ovarian failure in pre-menopausal women after stem cell transplantation (SCT) for malignancies.


METHODS
Thirty-one females were selected and prospectively followed in a university bone marrow transplantation unit and gynecologic outpatient clinic in a university teaching hospital. The patients received regular gynecological examinations, hormonal assessment every 6 months including plasma levels of luteinizing hormone (LH), follicle stimulating hormone (FSH), 17-beta estradiol (E2), and transvaginal pelvic ultrasonography, mammography, and computerized bone mineralometry every 12 months. Self-assessment form of menopausal symptoms perception was filled in by all patients before HRT and during the observation period.


RESULTS
All patients developed gonadal failure after SCT. The menopausal symptoms more frequently reported were: vasomotor (90%), muscleskeletal symptoms (61%), vulvo-vaginal atrophy (54%), and mood changes (54%). Fifteen premenopausal women out of 31 (51.6%) received systemic HRT on the basis of age (<45 years), absence of medical contraindication or subjective refusal, and complete remission of underlying malignancies post-SCT. The remaining patients (48.4%) did not receive HRT mainly for patient's refusal (29%), relapse of malignancy (13%) or liver toxicity (9.6%). HRT was effective in HRT treated patients promptly relieving unpleasant symptoms of gonadal failure. HRT was tolerated without minimal complications or serious side effects.


CONCLUSIONS
Dramatic improvement in menopausal symptoms was observed in women on HRT although treatment was feasible only in nearly half of the patients. HRT alleviates unnecessary discomfort and improves the well-being of female patients post-transplant also by preventing menopause related complications. Feasibility and patients' compliance of HRT should be carefully evaluated in long-term survivors after stem cell transplantation.
Piccioni
Paola
P
Instituto di Ematologia, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, 00168 Rome, Italy.
Scirpa
Paolo
P
D'Emilio
Ilenia
I
Sora
Federica
F
Scarciglia
Marilisa
M
Laurenti
Luca
L
De Matteis
Silvia
S
Sica
Simona
S
Leone
Giuseppe
G
Chiusolo
Patrizia
P
D000328:Adult; D004958:Estradiol / Q000008:administration & dosage; D015914:Estrogen Replacement Therapy; D005260:Female; D006801:Humans; D007558:Italy; D007938:Leukemia / Q000628:therapy; D008875:Middle Aged; D009640:Norethindrone / Q000008:administration & dosage; D010349:Patient Compliance; D016649:Primary Ovarian Insufficiency / Q000188:drug therapy* / Q000209:etiology / Q000473:pathology; D011446:Prospective Studies; D033581:Stem Cell Transplantation / Q000009:adverse effects*; D011795:Surveys and Questionnaires
D004958:Estradiol; D009640:Norethindrone