Optimal treatment of premature ovarian failure after treatment for Hodgkin's lymphoma is often withheld.
BACKGROUND
The purpose of this study is to determine: 1. the effect of treatment for Hodgkin's lymphoma on ovarian function, and 2. the interventions to relieve postmenopausal symptoms.


METHODS
Seventy-seven consecutive patients treated between 1989 and 2003 in the Rotterdam region for Hodgkin's lymphoma stages I and II were approached for this study. A questionnaire consisting of 45 questions was carried out to evaluate premature menopausal symptoms, hormonal replacement therapy and use of contraception, menstrual cycle, and subsequent pregnancies.


RESULTS
After informed consent 67 patients were willing to participate in the study and 66 patients filled in a questionnaire. After antitumor treatment 13 patients developed treatment-related premature ovarian failure, 35 patients had a spontaneous cycle, and 18 patients could not be classified as they used hormonal contraception. Women who developed treatment-related premature ovarian failure had a significantly higher mean age at the start of treatment for Hodgkin's lymphoma than women who remained premenopausal (p < 0.002). Only 6 of these 13 women (46%) received hormonal substitution. In all, 21 women conceived after antitumor treatment, and 28 children were born. All pregnancies were the result of spontaneous conception.


CONCLUSIONS
The effect of antitumor treatment for Hodgkin's lymphoma on ovarian function is age dependent (odds ratio of 1.18 per year). There is a striking inconsistency regarding the management of ovarian protection before and during antitumor treatment. Premenopausal women who undergo therapy for Hodgkin's lymphoma should be offered hormonal substitution therapy after loss of ovarian function.
Verschuuren
Sylvia I
SI
Department of Gynecologic Oncology, University Medical Center Rotterdam. Rotterdam, 3015 GD, The Netherlands.
Schaap
Jiska J
JJ
Veer
Mars B Van't
MB
Stijnen
Theo
T
Burger
Curt W
CW
Ansink
Anca C
AC
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000970:Antineoplastic Agents / Q000009:adverse effects; D015914:Estrogen Replacement Therapy; D005260:Female; D005500:Follow-Up Studies; D006689:Hodgkin Disease / Q000628:therapy*; D006801:Humans; D016649:Primary Ovarian Insufficiency / Q000209:etiology* / Q000517:prevention & control*; D011878:Radiotherapy / Q000009:adverse effects; D012189:Retrospective Studies; D016896:Treatment Outcome
D000970:Antineoplastic Agents