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Risk of Premature Ovarian Failure

The risk of permanent lack of menstrual cycles (amenorrhea and/or premature ovarian failure) in a woman of reproductive age following treatment for cancer or severe rheumatologic and autoimmune diseases depends on factors such as a patient's age, chemotherapy agent used and/or pelvic radiation therapy dosage. Chemotherapy and radiation therapy may directly damage or destroy the eggs in the ovaries, which can lead to premature menopause. Radiation to the pelvis can also lead to impairment in the lining of or blood flow to the uterus. 

The following are estimated risks of premature ovarian failure (listed from highest to lowest) and, consequently, loss of future fertility potential in a patient of reproductive age:

RISK

TREATMENT

High>80% High Dose External Beam Radiation to the Ovaries:
  • Adult women > 6 Gy
  • Post-Pubertal girls> 10 Gy
  • Pre-Pubertal girls > 15 Gy
    (Gy-Gray: Absorbed Dose of Radiation)

Bone Marrow Transplant or Stem Cell Transplant

  • Alkylating Agent Chemotherapy (Cyclophosphamide, Busulfan or Melaphan) in preparation for transplant

Breast Cancer Combination Chemotherapy in Women over 40 Yrs:  

  • Alkylating Agent Chemotherapy (Cyclophosphamide, Busulfan or Melaphan) plus Methotrexate, Fluorouracil, Doxorubicin plus Epirubicin
Intermediate
~ 30-70%
Breast Cancer  or Severe Autoimmune Disease Chemotherapy in Women 30-39 Yrs:   
  • Alkylating Chemotherapy (Cyclophosphamide, Busulfan Melphalan or Chlorambucil)
Breast Cancer Combination Chemotherapy in Women over  
40 yrs:
Alkylating Agent Chemotherapy (Cyclophosphamide, Busulfan or Melaphan) plus Doxorubicin

Low<20% Breast Cancer or Severe Autoimmune Disease Chemotherapy in Women less than 30 Yrs: 
  • Alkylating Agent Chemotherapy (Cyclophosphamide, Busulfan, Melaphan or Chlorambucil)

Breast Cancer Combination Chemotherapy in Women less
than 40 Yrs:  

  • Alkylating Agent Chemotherapy (Cyclophosphamide, Busulfan or Melaphan) plus Doxorubicin

  Cancer Chemotherapy for :

  • Leukemia (ALL, AML)
  • Non Hodgkin Lymphoma
Very Low/
None
Individual Chemotherapy or Radiotherapy Agents:
  • Vincristine
  • Methotrexate
  • Fluorouracil
  • Radioactive Iodine131
Unknown New Chemotherapy or Antibody Agents :
  • Taxanes (Paclitaxel-Taxol, Docetaxel-Taxotere)
  • Oxaliplatin (Eloxatin)
  • Irinotecan (Camptosar)
  • Bevacizumab (Avastin)
  • Cetuximab (Erbitux)
  • Trastuzumab (Herceptin)
  • Erlotinib (Tarceva)
  • Imatinib (Gleevec)