Fertility after a molar pregnancy, persistent disease or choriocarcinoma

Due to the high hCG levels 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 high risk chemotherapy combinations, such as EMA-CO, your periods will stop during treatment but usually start again afterwards within 3 to 6 months.

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 GTT 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, which means 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.

You can still have children after most treatments for GTT. 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 because it is important not to get pregnant straight away after you have had a GTT. There is more information about getting pregnant after a GTT below.

If you have a hysterectomy your womb is removed, so you won’t be able to have children afterwards. It is very rare to have this surgery for GTT. When planning your treatment, your doctor will talk to you about a hysterectomy if they think it may be necessary.

How soon it is safe to get pregnant after a GTT depends on the type of treatment you have had. If you only needed a D and C you can usually try to get pregnant as soon as your hCG levels have been normal for 6 months. If you became pregnant earlier you would have hCG in your blood and urine tests. This would make it difficult to monitor your GTT, and know for sure that your tumour is completely gone. The risk of the tumour coming back is highest in the first few months.

If you’ve had chemotherapy as part of your treatment, you will need to wait a year after finishing your chemotherapy before you try and get pregnant again.

It’s important to know that having a GTT 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 GTT. Even after chemotherapy treatment, the risk of a baby born with abnormalities is no higher than it would be normally.

Another thing to be reassured about is that the risk of having another molar pregnancy is low. More than 98 out of every 100 women (98%) who become pregnant following a molar pregnancy have a normal pregnancy. There is no increase in risk of complications in further pregnancies.

Doctors recommend that you don’t use the combined oral contraceptive pill until your hCG levels have gone back to normal. Taking this pill when your hCG levels are still up may make it more likely that you’ll need chemotherapy treatment. Condoms are the best type of contraceptive to use until the hCG gets back to normal. You should also avoid using any type of coil (IUD, intrauterine device) until your hCG levels go back to normal.