Fertility after gestational trophoblastic disease

Some women might want to try again for a baby after gestational trophoblastic disease (GTD). It is natural to wonder when you will be able to do this and whether you are at risk of GTD happening again. 

There are different types of GTD and these include:

• molar pregnancy
• invasive mole
• choriocarcinoma

Your periods and GTD

Due to the high levels of a hormone called human chorionic gonadotrophic hormone (hCG) in molar pregnancies, invasive mole and choriocarcinoma, your monthly periods stop. 

Surgery to treat a molar pregnancy might include dilation and suction evacuation (D and E) or dilation and curettage (D and C). After these operations, the hCG levels usually fall. And once the level is lower your periods will start again.

If you have chemotherapy your periods usually stop for the time you are having treatment. Some women who have methotrexate into their muscle will have irregular bleeding during their chemotherapy treatment. 

If you have a combination of chemotherapy drugs, your periods will stop during treatment. They usually start again within 3 to 6 months of 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 have a combination of chemotherapy drugs for GTD start 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. It is safe to have hormone replacement therapy after treatment for GTD. Your specialist can talk to you about this.

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. 

It is important not to get pregnant for a period of time after you have had GTD. It is possible get pregnant even before your periods have returned to normal. So you should follow the advice about contraception from your specialist team. If you do get pregnant before your team tell you it is safe, you should tell them straight away.

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 GTD. 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

It is important not to get pregnant again until your doctors say it is safe for you to try. This depends on:

• your type of GTD
• the treatment you have
• your hCG levels

If your only treatment was a D and C or D and E, 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.

If you have chemotherapy you will need to wait a year after finishing your treatment before you try and get pregnant again.

It’s important to know that having 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 GTD. Even after chemotherapy treatment, the chance of having a healthy baby is the same as for any other woman of the same age.

The risk of having another molar pregnancy is also low. Only about 1 out of 100 women (1%) have another molar pregnancy. There is no increase in the risk of complications in future pregnancies.

Contraception after GTD

It is safe to use contraception after treatment for GTD. Speak to your specialist team before starting any contraception. These include:

• oral contraceptive pill
• contraceptive patch
• implants
• depot injection
• intra uterine system (IUS)
• diaphragm or cap