RADIATION-INDUCED PREMATURE MENOPAUSE - A MISCONCEPTION

Purpose: To disprove the common view that women who have undergone irr adiation to fields excluding the pelvis are at risk for radiation-indu ced premature menopause, we reviewed menstrual function and fertility among women treated with subtotal lymphoid irradiation for Hodgkin's D isease. Methods and Materials: Treatment and follow-up records of all women less than age 50 at the time of diagnosis of Stage I or II supra diaphragmatic Hodgkin's Disease, treated with subtotal lymphoid irradi ation alone and enrolled in radiotherapy trials from 1967 to 1985, wer e reviewed. In addition, patients were surveyed regarding their menstr ual status and fertility history, Results: Thirty-six women, aged 10 t o 40 years, with normal menstrual function at the time of Hodgkin's di agnosis, were identified, Mean follow-up was 14 years, with a range of 1.25-22.75 years, The average radiation dose to mantle and paraaortic fields was 40-44 Gy; the calculated scatter radiation dose to the pel vis at the ovaries was 3.2 Gy, There were 38 pregnancies in 18 women; all offspring are normal, One of 36 women (2.7%) experienced premature menopause, The reported rate of premature menopause in women who have not undergone irradiation is 1-3%; not significantly different than t he rate in our study, There is a syndrome whereby antibodies to severa l endocrine organs occur (including the ovary), which is associated wi th premature ovarian failure, This syndrome may be associated with pri or radiation to the thyroid, such as that given by mantle irradiation for Hodgkin's Disease, We report such a case, Conclusion: There is lit tle risk of premature menopause in women treated with radiation fields that exclude the pelvis. Women with presumed radiation-induced premat ure menopause warrant an evaluation to exclude other causes of ovarian failure, such as autoimmune disorders.