Perturbations hormonales, fertilité et contraception après le traitement d'un cancer

Cancer is the second cause of death in women under 40 years of age in Western Europe and the United States. Survival after cancer treatment has improved during the past three decades. In line with this, procedures have been developed to optimize the quality of life, in particular the development of fertility-enhancing and fertility-preservation techniques. Surgery, chemotherapy and radiotherapy affect the fertility potential of women in different ways and to different degrees. Surgery has a direct impact by removing the uterus and ovaries. Radiotherapy (external or brachytherapy) may affect ovarian and also uterine function. Different drugs used in chemotherapy may directly influence ovarian function. Some markers have now been evaluated that are predictive of the potential toxic injury to the gonads and uterus. Various procedures could be proposed to preserve fertility potential in women, before delivering anticancer treatments or after treating the tumor. However, such treatments can only be considered if they do not have deleterious consequences on the survival of patients. As well as the preservation of fertility, there is the issue of contraception; and in the case of impaired ovarian function, the issue of a substitute hormonal treatment.