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Menopause vs. Infertility After Cancer: What’s the Difference?

Women and girls who undergo radiation and chemotherapy to treat cancer or other diseases are a significant risk of going into premature menopause and infertility. Menopause and infertility, while related, are not the same thing and it is important to understand the difference. Menopause is the stage in a woman’s life when her hormonal milieu changes, she stops having her period, and can no longer conceive. Thrusting young female survivors into early menopause puts them at increased risk for osteoperosis, heart disease, decreased sexual drive, and other conditions. In contrast, infertility can still occur in women who do have monthly periods and have premenopausal hormone levels. Research to develop new fertility preservation techniques measure menopause and infertility differently and it is important for the public to understand this as well.

An article recently came out in the Journal of the American Medical Association with data indicating that a drug may be able to prevent premature menopause in cancer patients. The drug, called a gonadotropin releasing hormone (GnRH) agonist, mimics a woman’s own GnRH and may put the woman’s ovaries into an inactive state. When taken during chemotherapy, the drug may protect the ovaries from some of the harmful effects of treatment, although the exact mechanism in preventing early menopause is unclear. The study, by Del Mastro, Boni, and Michelotti, examined resumption of periods after chemotherapy and the levels of follicular stimulating hormone (FSH) and estrodiol (a form of estrogen) after women took the drug. Women on the drug during chemotherapy were more likely to resume their periods and have premenopausal levels of FST and estrodiol than those who received chemotherapy alone.

While prevention of premature menopause is good news, many media outlets learned of the research and wrote articles on how the agonist may prevent infertility, not just menopause. Titles such as, “Breast Cancer Patients Prevent Infertility With New Treatment,” further misinformed the public. As many cancer survivors have experienced first hand, patients may regain normal periods but have reduced or complete loss of fertility. Only long-term studies of survivors who used GnRH agonists during chemotherapy, will we be able to determine whether this treatment also preserves fertility. In the meantime, cryopreservation of eggs, embryos, or ovarian tissue is still the best bet. We look forward to the results!

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