Unique Issues in Oncological Patients: From Amenorrhea to Fertility Preservation

Cancer is an important cause of morbidity and mortality worldwide. At the time of diagnosis, a significant proportion of young women experience unique treatment and survivorship issues centering on treatment-related amenorrhea, including fertility preservation and management of ovarian function as endocrine therapy. Chemotherapy-induced amenorrhea is a well-known toxicity after chemotherapy in young cancer patients that has traditionally referred as a marker of infertility: the link between adjuvant chemotherapy and amenorrhea has been well established. Chemotherapy-induced amenorrhea is not the only situation of menstrual absence: obstetrician–gynecologists frequently are consulted before the initiation of cancer treatment to request menstrual suppression before the initiation of cancer treatment or during an episode of severe heavy bleeding to stop bleeding emergently. Considering the rising trend in delaying childbearing and the higher number of patients who have not completed their family planning at the time of diagnosis, the demand for fertility preservation and information about the feasibility and safety of pregnancy following treatment completion is expected to increase. Oncofertility counselling should be individualized. The ability to predict which patients will experience transient or permanent loss of menstrual function is important in counseling patients on the risks of chemotherapy, potential benefits of fertility preservation, and the management of ovarian function during adjuvant endocrine therapy.