What would cause fertility issues after ABVD therapy?

Question

Hello doctor,

I hope you are doing well. I completed treatment for Hodgkin lymphoma eight months ago, which included ABVD chemotherapy and chest radiation. I am very grateful to be in remission; however, I am experiencing several ongoing concerns related to my reproductive and hormonal health that I would appreciate your guidance on.

Since completing treatment, I have not had a menstrual period. My oncologist mentioned that this could be either temporary or permanent, depending on the impact of chemotherapy on my ovaries. At 25 years old, the possibility of impaired fertility has been emotionally challenging, especially as I hope to have children in the future. I was unprepared for how distressing this uncertainty would feel.

In addition, I am experiencing significant menopausal-type symptoms, including hot flashes, night sweats, vaginal dryness that makes intercourse uncomfortable, and mood changes that are affecting my relationship with my fiancé. I would like to know whether hormone replacement therapy might be appropriate or beneficial at my age.

I also have concerns regarding the long-term effects of chest radiation, particularly my risk for breast cancer. I am unsure how to perform effective breast self-examinations due to scar tissue and would like guidance on appropriate screening and surveillance.

Another change that has been difficult emotionally is the loss of body hair, including pubic hair, which has affected my sense of femininity and self-confidence.

I would appreciate your advice on the following:

How can we determine whether my ovaries are still functioning following chemotherapy?
What fertility options are available if I have experienced permanent ovarian failure?
When might my menstrual cycles return, and at what point should I be concerned if they do not?
How does prior chest radiation affect my future breast cancer risk, and what screening is recommended?

I truly appreciate your guidance as I navigate these post-treatment challenges.

Thank you very much for your time and support.

Answer 1

Hi,

Welcome to icliniq.com.

I hope everything is okay with you.

What you are going through is absolutely normal. People generally think that finishing treatment and going into remission will bring comfort, but for many young survivors, it is followed by a second, unexpected wave of grief over not being able to have children, changes in their bodies, and a future that suddenly appears uncertain. These feelings are real, make sense, and need to be cared for and paid attention to.

After Adriamycin, Bleomycin, Vinblastine, Dacarbazine (ABVD) chemotherapy, your periods may come back within a few months, take a few years to come back, or, in some circumstances, not come back at all. This is true for both your menstrual cycles and your ovaries. It is not possible to say exactly when or if your periods will come back because this depends on how sensitive the ovaries were to treatment. Because you are still young, there is still a good chance that your ovaries may recover. However, the fact that you have not had a period in eight months and are experiencing menopausal symptoms implies that your ovaries are not working properly right now.

I suggest doing the following blood tests to get a better idea of your ovarian reserve and function: Follicle-Stimulating Hormone (FSH), Luteinizing Hormone (LH), estradiol, and Anti-Müllerian Hormone(AMH). These results can give you useful information about the activity of the remaining ovaries. It is also a good idea to examine your thyroid function. Once these results are in, it would be a good idea to talk to a gynecologist about them in depth.

Hormone replacement therapy can be very useful for young women whose ovaries have stopped working due to treatment. It can help with menopausal symptoms and overall health. Talk to your gynecologist about this to find out what the safest and best way to do it is for you.

If your ovaries start working again, spontaneous conception may still be feasible, and egg freezing may still be an option. If ovarian failure is permanent, In Vitro Fertilization (IVF) using donor eggs is still an option for getting pregnant. It is really important to talk to a reproductive endocrinologist who has worked with cancer survivors to properly explore these choices.

Radiation to the chest at a young age does raise the risk of breast cancer in the long term. Most of the time, the current recommendations say that women should get an annual breast MRI and an annual mammogram, commencing eight years following radiation therapy or by age 25, whichever comes later. Your doctor can develop a screening strategy that works for you.

When it comes to hair loss, especially pubic hair, regeneration may happen slowly over time, but it may not always come back completely. Hair does not define femininity, but that doesn't make this loss any less sad. Your feelings about it are completely valid.

You lived through cancer when you should have been making plans for the future, not wondering if your body had failed you. Even if you are thankful to be alive, it is okay to feel furious, upset, scared, and grieving. All of these sensations can be together.

Please feel free to share your valuable feedback for improved patient care.

Thank you.