Related Experiment Video
Updated: Apr 25, 2026
Z-Scores for Assessing Ovarian Reserve in Young Patients Undergoing Fertility Preservation
Published on: October 25, 2024
Risk of premature menopause after treatment for Hodgkin's lymphoma
Anthony J Swerdlow1, Rosie Cooke1, Andrew Bates1
1Divisions of Genetics and Epidemiology (AJS, RC), Breast Cancer Research (AJS) and Radiotherapy (AH), Institute of Cancer Research, Sutton, UK; University of Manchester and Christie NHS Foundation Trust, Manchester, UK (JR); Gastrointestinal Unit, Royal Marsden Hospital, Sutton, UK (DC); Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, UK (IS); Cancer Research UK Medical Oncology Unit, St. Bartholomew's Hospital, London, UK (TAL); Cancer Centre, Mount Vernon Hospital, Middlesex, UK (PJH); St. James Institute of Oncology, Leeds, UK (DG); Northern Centre for Cancer Care, Freeman Hospital, Newcastle, UK (HHL); Bristol Haematology and Oncology Centre, Bristol, UK (SJF); Addenbrooke's Hospital, Cambridge, UK (MVW); Academic Unit of Clinical Oncology, Weston Park Hospital, Sheffield, UK (BWH); Guy's and St. Thomas, London, UK (SJH); Department of Haematology, University College Hospital, London, UK (DCL); Southampton General Hospital, Southampton, UK (AB); Queen Elizabeth Hospital, Birmingham, UK (AMS). The England and Wales Hodgkin Lymphoma Follow-up Group includes the authors of this article plus: Gabriel Anghel, Lincoln Hospital; Brian Attock, North Devon District Hospital; Jane Barrett, Royal Berkshire Hospital; Andrew Bell, Poole Hospital; Kim Benstead, Cheltenham General Hospital; Eric M. Bessell, Nottingham University Hospital; Ashoke Biswas, Royal Preston Hospital; Norbert Blesing, Great Western Hospital, Swindon; Caroline Brammer, New Cross Hospital, Wolverhampton; Jill Brock, Clatterbridge Centre for Oncology; Alison Brownell, Queens Hospital, Romford; A. Murray Brunt, University Hospital of North Staffordshire; Peter B. Coates, Queen Elizabeth Hospital, King's Lynn; Matthew P. Collinson, Royal Cornwall Hospital; Neville Davidson, Essex County Hospital; Sian Davies, North Middlesex University Hospital; Ian Fentiman, Guy's Hospital; Eve Gallop-Evans, Velindre Hospital; Angel Garcia, Glan Clwyd Hospital; Andrew Goodman, Royal Devon and Exeter Hospital; Ad
Background:
Modern treatment of Hodgkin's lymphoma (HL) has transformed its prognosis but causes late effects, including premature menopause. Cohort studies of premature menopause risks after treatment have been relatively small, and knowledge about these risks is limited.
Methods:
Nonsurgical menopause risk was analyzed in 2127 women treated for HL in England and Wales at ages younger than 36 years from 1960 through 2004 and followed to 2003 through 2012. Risks were estimated using Cox regression, modified Poisson regression, and competing risks. All statistical tests were two-sided.
Results:
During follow-up, 605 patients underwent nonsurgical menopause before age 40 years. Risk of premature menopause increased more than 20-fold after ovarian radiotherapy, alkylating chemotherapy other than dacarbazine, or BEAM (bis-chloroethylnitrosourea [BCNU], etoposide, cytarabine, melphalan) chemotherapy for stem cell transplantation, but was not statistically significantly raised after adriamycin, bleomycin, vinblastine, dacarbazine (ABVD). Menopause generally occurred sooner after ovarian radiotherapy (62.5% within five years of ≥5 Gy treatment) and BEAM (50.9% within five years) than after alkylating chemotherapy (24.2% within five years of ≥6 cycles), and after treatment at older than at younger ages. Cumulative risk of menopause by age 40 years was 81.3% after greater than or equal to 5Gy ovarian radiotherapy, 75.3% after BEAM, 49.1% after greater than or equal to 6 cycles alkylating chemotherapy, 1.4% after ABVD, and 3.0% after solely supradiaphragmatic radiotherapy. Tables of individualized risk information for patients by future period, treatment type, dose and age are provided.
Conclusions:
Patients treated with HL need to plan intended pregnancies using personalized information on their risk of menopause by different future time points.
