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The effects of children's cancer therapy on female reproductive function depend on many factors, including the person's age at the time of cancer therapy, the specific type and location of the cancer, and the treatment that was given. It is important to understand how the ovaries and female reproductive organs function and how they may be affected by therapy given to treat cancer during childhood.
At birth, a girl's ovaries contain all the eggs they will ever have. When it is time for a girl to begin pubertal development, the pituitary gland in the brain signals the ovaries by releasing two hormones: FSH and LH. The ovaries secrete the female hormones, estrogen and progesterone, necessary for reproductive function. During each menstrual cycle, at least one egg usually matures and is released from the ovaries. If the egg is not fertilized, menstruation begins. The cycle then repeats itself about every 28 days. With each menstrual cycle, the supply of eggs decreases. When most of the eggs are depleted from a woman's ovaries, menopause begins. During menopause, the menstrual cycles stop, the ovaries stop making hormones, and the woman is no longer able to become pregnant.
Certain chemotherapy drugs, radiation therapy, and surgery can sometimes damage the ovaries, reducing the reserve supply of eggs. When the ovaries are not able to produce eggs or hormones, this is called ovarian failure.
Chemotherapy of the "alkylator" type (such as cyclophosphamide, nitrogen mustard, and busulfan) is most likely to affect ovarian function. The total dose of alkylators used during cancer treatment is important in determining the likelihood of ovarian damage. With higher total doses, the likelihood of damage to the ovaries increases. If treatment for children's cancer included a combination of both radiation and alkylating chemotherapy, the risk of ovarian failure may be increased.
Radiation therapy can affect ovarian function in two ways:
Radiation therapy to any of the following areas:
Chemotherapy - the class of drugs called "alkylators" can cause ovarian failure when given in high doses. Examples of these drugs include:
Women with these risk factors should be followed closely by an obstetrician who is qualified to care for women with high-risk pregnancies.
Females who have had any cancer treatments that may affect ovarian function should have a yearly check-up that includes careful evaluation of menstrual history, hormonal status, and progression through puberty. Blood may be tested for hormone levels (FSH, LH, and estradiol). If any problems are detected, a referral to an endocrinologist (hormone specialist) and/or other specialists may be recommended. For women with ovarian failure, a bone density test (special type of X-ray) to check for thinning of the bones (osteoporosis) may also be recommended.