Find out about fertility after a diagnosis of molar pregnancy, persistent disease or choriocarcinoma.
Your periods and GTD
Gestational trophoblastic disease (GTDs) 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 chemotherapy combinations, such as etoposide, methotrexate, actinoymcin D, cyclophosphamide and vincristine (EMACO), 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 GTD 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.
Your fertility after GTD
You can still have children after most treatments for GTD. 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 GTD.
You won’t be able to have children, if you need to have your womb removed (a hysterectomy). But 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 might be necessary.
Getting pregnant again after GTD
How soon it is safe to get pregnant after a GTD depends on the type of treatment you have had. If your only treatment was a D and C, 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 GTD, and know for sure that it has completely gone. The risk of GTD coming back is highest in the first few months.
You will need to wait a year after finishing your treatment before you try and get pregnant again, if you have chemotherapy .
It’s important to know that having a GTD 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 GTD. 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.
Contraception after GTD
It is safe to use contraception after treatment for GTT. This includes the oral contraceptive pill, implants and depot injection.