Patient's Query
Hello, Doctor,
I am a 33 year old woman recently diagnosed with Hodgkin lymphoma, stage IIA. The biopsy confirmed the nodular sclerosis type. I have been on ABVD chemotherapy for the past three months, and while my latest PET-CT shows a limited response, I am extremely anxious about fertility.
My periods have become irregular, and sometimes I miss them entirely. I was planning to start a family next year, but now I’m unsure if I will be able to conceive naturally. Also, my hemoglobin is 9.5 g/dL, and I feel constantly fatigued and dizzy. Please tell me,
Could the chemotherapy be causing early menopause or ovarian damage?
Are there any fertility preservation options that can still be considered mid-treatment?
Is my anemia from the chemotherapy or the lymphoma itself?
What can I do to manage these symptoms safely while continuing treatment?
Can hormonal therapy help restore my cycles after chemotherapy ends?
Kindly help.
Hello,
Welcome to icliniq.com.
I read your query and can understand your concern.
Chemotherapy with the ABVD regimen (Adriamycin, Bleomycin, Vinblastine, Dacarbazine) used for Hodgkin lymphoma is among the less gonadotoxic (less damaging to ovaries) chemotherapy regimens compared with others.
However, you can experience the following issues,
Temporary menstrual irregularities are common due to suppression of ovarian function during chemotherapy.
Permanent ovarian failure (early menopause) risk increases with age and cumulative dose, but at 33, your ovaries often recover within several months after completing treatment.
The fact that your periods are irregular, not absent from the start, suggests temporary suppression rather than complete ovarian failure.
Still, fertility can not be guaranteed, and it is very good that you are thinking about this early. Fertility preservation is a good option for you, and it is ideally done before starting chemotherapy, but there are still a few options even now:
Ovarian suppression with GnRH agonists such as Leuprolide or Goserelin during chemotherapy can reduce the risk of ovarian damage. This approach is sometimes started even after initial cycles, you can discuss with your oncologist if it’s still worthwhile.
Ovarian tissue cryopreservation can sometimes be done during treatment breaks, though it is more complex and not always feasible mid-therapy.
After treatment, if ovarian function does not recover, egg donation or embryo transfer using stored embryos can be considered later. You should request a referral to a reproductive endocrinologist or fertility specialist experienced in oncology patients.
Your hemoglobin of 9.5 grams per deciliter (g/dL) is mild-to-moderate anemia. This can be related to chemotherapy-induced bone marrow suppression (most common during ABVD). You can take the following medications,
Tablet Ferrous sulphate 200 milligrams (mg), one every night for two months.
Tablet Cholecalciferol 200,000 international units (IU), one tablet every 15 days for 6 months
I hope this information helps you.
Feel free to ask further queries.
Thank you.
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