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Female Reproductive Health Issues

Some female childhood cancer survivors may experience problems with their reproductive health — menstrual periods, pregnancy, and childbearing — because of certain treatments they received.

The effect, if any, depends on the:

  • Tissues and organs involved in the cancer
  • Type, dosage, and combination of treatment
  • Patient’s age at the time of treatment

How the Female Reproductive System Works

The organs of the female reproductive system work together so a woman can get pregnant, carry a developing human until time for delivery, and give birth.

Females have 2 ovaries. During puberty, the pituitary gland in the brain signals the ovaries to start making more estrogen and progesterone. These are hormones necessary for the reproductive system to work.

Once a month, the ovaries release at least 1 egg. If the egg is fertilized by sperm, the female becomes pregnant. If it is not fertilized, the woman will menstruate. 

A girl is born with all the eggs she will ever have. When her supply becomes low, a woman begins menopause. When menstrual periods stop, a women cannot get pregnant anymore. The average age of menopause is 51, but it can begin as early as age 40.

This illustration shows a teen with her uterus, fallopian tubes, ovaries, cervix, and vagina labeled. To the right of the main image, the endocrine system organs are also shown against the silhouette of the young woman’s body: pineal gland, hypothalamus, pituitary gland, thyroid and parathyroid, thymus, adrenal gland, and pancreas.

The organs of the female reproductive system work together so a woman can get pregnant, carry a developing human until time for delivery, and give birth.

Cancer Treatments That Can Affect Female Health

  1. Chemotherapy with high doses of alkylating drugs can damage ovaries.

    Alkylating Drugs
    Heavy  Metal Drugs
    Non-classical alkylators
  2. Radiation therapy that affects a patient’s pelvic area, reproductive organs, and pituitary gland may affect a patient’s fertility. The treatment may decrease the number of eggs or affect the quality of the eggs.

    Abdomen/pelvic/ total body radiation

    Radiation directly to or near the ovaries can cause them to stop working. Radiation therapy to the abdomen, pelvis, and lower spine can affect the uterus and increase the risk of miscarriage, premature labor, low birth weight, and problems during labor.

    Brain/ hypothalamus/ pituitary gland

    The pituitary gland produces two hormones needed for the ovaries to function correctly – FSH (follicle-stimulating hormone) and LH (luteinizing hormone.) FSH stimulates the ovarian follicles to produce eggs. LH signals the follicles to release eggs. High levels of radiation to this area of the brain can lead to low levels of these hormones.

    Pelvic radiation and alkylating agent combination

    The combination of pelvic radiation and high doses of alkylating agents causes the highest risk of damage to reproductive function.

  3. Tumors and / or surgery that result in damage to the pituitary gland can cause the ovaries to stop working due to deficiency in LH and FSH. This condition is called central hypogonadism.

    Surgery that removes both ovaries before the normal age of menopause causes ovarian failure.

    Removal of 1 ovary before the normal age of menopause can cause menopause to happen sooner.


In general, females who are adolescents and young adults at the time of treatment are at higher risk for problems than younger girls.

Problems That May Occur

  1. Damage to ovaries can cause puberty to be delayed (no signs of breast development after age 13 years) or to stall (no progress in signs of puberty, no onset of periods past the age of 16 years). Affected girls will need hormone treatment prescribed by a doctor to experience puberty and have a menstrual period.

  2. Many females will temporarily stop having their period during treatment, but it may return later. That timing is unpredictable. It could take several years in some cases. It is important that women take birth control if they don’t want to become pregnant.

  3. Cancer treatment can cause women to stop menstruating earlier than expected (before the age of 40.) Many heath care professionals recommend that women at risk for early menopause not put off trying to have children beyond the early 30s.

  4. Women with ovarian failure don’t produce enough estrogen, which is needed for reproduction, healthy bones, a healthy heart, and overall well-being. Girls at risk for this problem may need to consult an endocrinologist.

    Lack of female hormones represents a problem with the endocrine system.

    Lack of female hormones represents a problem with the endocrine system.

  5. Infertility is the inability to produce children. Women at risk for infertility may want to see a fertility specialist.

  6. Women may be at increased risk for miscarriage, premature delivery, low birthweight infants, or problems during labor. Women who had chemotherapy with anthracyclines could have heart problems during pregnancy and labor. Survivors who are planning to become pregnant or are already pregnant should have a heart muscle function evaluation. Women with these health needs should visit an obstetrician who specializes in high-risk pregnancies.

What Survivors Can Do

Survivors should have annual physical examinations that include:

  • Checking of the progress of puberty
  • Menstrual cycle and pregnancy history
  • Sexual function
  • Blood tests for FSH, LH and estradiol. Estradiol is a form of the female hormone estrogen.

If the health care provider sees problems in these areas, he or she may refer the survivor to an endocrinologist or other specialists.

Treatments are available for many conditions that affect hormones and fertility.

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Reviewed: June 2018