Fertility after a molar pregnancy, persistent disease or choriocarcinoma
This page tells you about planning a pregnancy after a diagnosis of gestational trophoblastic tumour (GTT). There is information about
Fertility after gestational trophoblastic tumour (GTT)
These tumours cause high levels of a hormone called human chorionic gonadotrophin (hCG). This makes your periods stop. Once the hCG levels go back to normal, your periods start again. If you have chemotherapy your periods will probably stop temporarily. And you might go through the menopause earlier than you would if you didn’t have treatment.
You can still have children after most treatments for GTT. But it is important not to get pregnant straight away after a GTT. If your only treatment was a D and C, you can usually try to get pregnant as soon as your hCG levels have been normal for 6 months. If you’ve had chemotherapy, you will need to wait a year after finishing your chemotherapy before you try to get pregnant again. Having a GTT does not increase your risk of having a baby with abnormalities. And the risk of another molar pregnancy is very low.
Doctors recommend that you don’t use the combined oral contraceptive pill until your hCG levels return to normal. Taking it when your levels are still up may make it more likely that you’ll need chemotherapy treatment. You should also avoid using any type of coil (IUD, intrauterine device) until your hCG levels get back to normal.
You can view and print the quick guides for all the pages in the living with a gestational trophoblastic tumour section.
Gestational trophoblastic tumours (GTTs) also called gestational trophoblastic neoplasia (GTN) include molar pregnancies that need chemotherapy, choriocarcinoma, placental site trophoblastic and epithelioid trophoblastic tumours. Due to the high levels of a hormone called hCG in molar pregnancies, persistent trophoblastic disease and choriocarcinoma, your monthly periods stop. After a D and C for molar pregnancy the hCG levels usually fall and once the level goes back to normal your periods will start again.
If you have chemotherapy treatment this usually stops your periods for the time you are having treatment. But some women having methotrexate into their muscle find that their periods start again during the chemotherapy once their hCG goes back down to normal.
With high risk chemotherapy combinations, such as EMA-CO, your periods will stop during treatment. But they usually start again within 3 to 6 months of the treatment ending.
After treatment some women go through the menopause at a younger age than if they had not had treatment. Studies have shown that women who had a combination of chemotherapy drugs for GTT went into the menopause about 3 years earlier than usual. Older women (over the age of 45) may find that their periods don’t come back at all after chemotherapy treatment. So they go through an early menopause at the time of treatment.
Signs of the menopause include a change in your periods and symptoms such as hot flushes. If you have any symptoms of early menopause let your GP or specialist know.
You can still have children after most treatments for GTT. And it is still possible to become pregnant if you’ve had chemotherapy treatment. Your specialist team will advise you about which contraception to use. It is important not to get pregnant straight away after you have had a GTT. There is information about getting pregnant after a GTT below.
If you have a hysterectomy your womb is removed, so you won’t be able to have children afterwards. It is very rare to have this type of surgery for GTT. When planning your treatment, your doctor will talk to you about a hysterectomy if they think it may be necessary.
How soon it is safe to get pregnant after a GTT depends on the type of treatment you have had. If a D and C was your only treatment, you can usually try to get pregnant as soon as your hCG follow up is complete. If you became pregnant earlier you would have hCG in your blood and urine tests. This would make it difficult to monitor your GTT, and know for sure that your tumour is completely gone. The risk of the tumour coming back is highest in the first few months.
If you’ve had chemotherapy as part of your treatment, you will need to wait a year after finishing your chemotherapy before you try and get pregnant again.
It’s important to know that having a GTT does not increase your risk of having a baby with abnormalities. Your risk of this happening is no greater than it would be if you hadn’t had a GTT. Even after chemotherapy treatment, the chance of having a healthy baby is the same as for any other woman of the same age.
Another thing to be reassured about is that the risk of having another molar pregnancy is low. Only 1 out of 100 women (1%) have another molar pregnancy. There is no increase in the risk of complications in further pregnancies.
It is safe to use contraception after treatment for GTT. This includes the oral contraceptive pill, implants and depot injection.
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