OVARIAN RECOVERY AFTER TOTAL-BODY IRRADIATION AND ALLOGENEIC BONE-MARROW TRANSPLANTATION - LONG-TERM FOLLOW-UP OF 79 FEMALES

Seventy-nine females undergoing allogeneic BMT following conditioning with total body irradiation (TBI), were prospectively followed between March 1983 and March 1992 with regular gynaecological examinations, i ncluding plasma levels of luteinising hormone (LH), follicle stimulati ng hormone (FSH), 17-beta oestradiol (E2) and pelvic ultrasonagraphy. The end-points of this study were the following: (1) early and late ef fects of TBI on ovarian function, (2) compliance and results of hormon al replacement therapy (HRT), and (3) predictive events for ovarian re covery. During the first year post-BMT most adult women complained of vasomotor and/or genitourinary tract symptoms. These were associated w ith decreased E2 and increased LH-FSH plasma levels and a deterioratio n in their sexual life (94% of sexually active women). Forty-nine adul t females were selected to receive systemic hormonal replacement thera py (HRT), consisting of cyclic transdermal oestrogens plus medroxyprog esterone acetate (MPA) or cyclic oral therapy with low doses of conjug ated oestrogens and MPA: these patients were selected on the basis of age (< 45 years), absence of medical contraindications or subjective r efusal. Compliance and tolerability were overall good: most women (65% ) never stopped HRT; this was discontinued in 14 patients for medical reasons and in 3 because of refusal. Forty-three females completed 6 m onths of HRT: vasomotor symptoms disappeared in 91% of 58 women who pr eviously referred these symptoms. Improvement of genitourinary symptom s was seen both with local and systemic hormonal therapy. However sexu al symptoms were reduced in 21 of 26 women (81%) given HRT compared wi th 8 of 19 (42%) women given local treatment (p = 0.02). The actuarial chance of having a menstrual period at 10 years post-BMT was 43%: it was 100% in pre-menarchal females and 36% in post-menarchal females (p = 0.003). In the latter group it was 100% if < 18 and 15% if > 18 yea rs of age (p = 0.001). One patient became pregnant in March 1993, 6 ye ars post-BMT, at the age of 34 years and gave birth to a healthy baby. In conclusion, ovarian failure is common following TBI; subjective sy mptoms can be significantly improved with HRT. Gonadal recovery is see n in a proportion of females and is dependent on the age and the menar chal status at the time of BMT.