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Title: The reproductive health of women treated for cancer in childhood
Author: Bath, Louise E.
Awarding Body: University of Edinburgh
Current Institution: University of Edinburgh
Date of Award: 2005
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This thesis addresses aspects of hypothalamic, pituitary, ovarian and uterine function in post pubertal women following treatment for cancer in childhood. The effect of low dose cranial irradiation (18-24 Gray) on gonadal function was evaluated in long-term survivors of childhood leukaemia. Tracking of urine luteinising hormone (LH), oestrone and pregnandiol demonstrated reduced LH secretion throughout the cycle and particularly during the LH surge, short luteal phases and decreased oestrone production. These data indicate that treatment for childhood leukaemia results in a subtle ovulatory disorder in some patients, probably related to cranial irradiation. Women treated for childhood cancer, who have progressed spontaneously through puberty and have regular menstrual cycles, may still be at risk of an early menopause. Ovarian reserve was assessed in women with regular menstrual cycles and women with a history of regular cycles who were using the oral contraceptive pill (OCP), for contraception. They were investigated before and 24 hours after an injection of follicle stimulating hormone (FSH). Women with regular cycles had significantly higher basal FSH, and lower anti-Mullerian hormone levels, and reduced ovarian volume. Women on the OCP had a reduced inhibin B response to FSH and lower antral follicle counts. Therefore, both groups showed hormonal and biophysical evidence of partial loss of ovarian reserve. Radiotherapy to the abdomen carries a high risk of ovarian failure. The effect on the uterus is less well documented. Ovarian and uterine function were evaluated in women who had received total body irradiation in childhood (14.4 Gray). In women with ovarian failure, uterine function was evaluated before and after 3 months of physiological sex steroid replacement (pSSR). At baseline, uterine artery blood flow and thickening of the endometrial were not detectable. After 3 months of pSSR neither blood flow or endometrial thickness were different from controls. Uterine volume remained smaller, and there was a correlation with age at irradiation. Endometrial samples were obtained and the histology and histochemistry of the endometrium were normal compared with controls. Hormone replacement therapy and achieves physiological sex steroid concentrations improves uterine size, blood flow and endometrial development. For those young women that have ovarian failure there is no good evidence as to the optical method of pubertal induction and subsequent cyclical hormone replacement therapy. UK practice was evaluated by postal questionnaire sent to all British Endocrinologists who were members of the European Society for Paediatric Endocrinology.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (M.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available