Menstrual patterns and gonado-sexual health following hematopoietic transplant in reproductive age women and the role of hormone replacement therapy.

Abstract

Background: Menstrual patterns, reproductive sequelae, sexual health, and the role of hormone replacement therapy (HRT) among women following hematopoietic stem cell transplantation (HSCT) remain underexplored. This study evaluated menstrual resumption, ovarian reserve, fertility outcomes, sexual function, and attitudes towards HRT among women who underwent HSCT.

Methods: This single-centre retrospective, cross-sectional analysis included women aged 18-45 years who had undergone HSCT for haematological malignancies and were on follow-up of at least 6 months post-HSCT. Data collected encompassed demographic details, disease characteristics, prior treatments, and transplant details. Menstrual patterns, anti-Müllerian hormone (AMH) levels, antral follicular counts (AFC), and the female sexual function index (FSFI) were measured among HSCT recipients at the time of study recruitment and compared with 30 age-matched healthy controls. Women with premature ovarian insufficiency (amenorrhea and follicle stimulating hormone [FSH] > 40 IU/L) were offered HRT. Among women who were administered HRT, 6 months follow-up menstrual resumption rates and FSFI assessments were done.

Results: Among the 30 women enrolled, 86.6% (26/30) of patients had normal menstruation pre-HSCT, which declined to 23% (7/30) post-HSCT (p < 0.001). The median AMH level in the cases was 0.01 ng/mL (Range: 0.01-0.76), which was significantly lower than that of the controls (median: 2 ng/mL, range: 0.11-8.11). The AFC (median: 0, range: 0-5) was also significantly lower in HSCT recipients compared to controls (median: 11, range: 3-19) (p < 0.001). None of the HSCT recipients exhibited normal ovarian reserve post-HSCT. The proportion of patients with AMH levels above 0.01 ng/mL was higher in the subgroup that had return of spontaneous menses (n=5/7, 71.4%) compared to the subgroup that did not have return of menses (n=4/23, 17.4%); p=0.01. Similarly, the proportion of patients with an AFC greater than 1 was higher in the subgroup that resumed menstruation (6/7, 85.7%) compared to those who did not resume menstruation (3/23, 13%); p < 0.001. Among women desiring pregnancy, two achieved spontaneous conception resulting in healthy live births. A majority (24/26, 92.7%) of sexually active women exhibited sexual dysfunction (FSFI < 26.5) post-HSCT. HRT was offered to 23 women with premature ovarian insufficiency; however, 52.2% refused therapy. Among those who received HRT for at least six months, a significant improvement in the FSFI score was observed (p < 0.03).

Conclusions: Ovarian and sexual dysfunction are frequent in post-HSCT women; a subset resumes spontaneous menstruation. Spontaneous conceptions may be observed despite low ovarian reserve markers. HRT may have a potential role to improve sexual and menstrual functions.