Reproductive health care across the lifecourse of the female cancer patient

Abstract

Reproductive health is a key component of cancer care and survivorship, encompassing gynecologic issues ranging from contraception and fertility to treatment of sexual dysfunction and menopause. Yet, oncology providers are often unfamiliar with the management of gynecologic issues. In order to address the unmet needs of female cancer patients, reproductive health should be addressed at the time of cancer diagnosis and continue through survivorship. Universal screening for pregnancy intention can guide counseling on contraception and fertility preservation. Safe and efficacious contraceptive options for both patients undergoing active treatment and cancer survivors are available and can often offer non-contraceptive benefits such as regulation of menses. Prompt referral to reproductive endocrinology specialists allows patients to explore options for fertility preservation prior to the receipt of cancer-directed therapies. Due to a rapid drop in hormone levels, treatment-induced menopause often results in severe symptoms. In patients with induced menopause, balancing the risks of hormone therapy compared to the decreased quality of life and health concerns associated with early menopause may help patients with difficult decisions regarding symptom control. Cancer treatment impacts sexual function with both physical changes to the vulvovaginal tissues and altered relationship dynamics. Open discussions on the impact to sexual health are paramount to quality of life after cancer. While more data is needed in many areas, proactive management of reproductive health issues is crucial to quality of life in cancer survivorship. In this article, we review contemporary management of the reproductive health of the female cancer patient.