Thriving, or just surviving? Exploring women’s reproductive health after colorectal cancer

Reading time: 6 minutes

Xanthea Heighington

Introduction

Colorectal cancer survival rates are improving, with the American Cancer Society recently having reported a 1.5% decrease in deaths associated with the disease. Such improvements are particularly notable in younger adults [1]. However, survival statistics are just that – survival. They don’t capture quality-of-life outcomes, particularly relating to reproductive health. Many women are diagnosed before menopause, during their child-bearing years. So this raises an important question – what does ‘survival’ actually look like for those hoping to start a family after their diagnosis?

Why this matters now

In 2025, the BMJ reported the results of a large global analysis, indicating that bowel cancer is the only cancer that is increasing in younger adults faster than in older adults [2]. Figures from Cancer Research UK specifically highlight the number of new cases identified in younger females over the period 2017-2019 (Table 1) [3].

Table 1. New cases of bowel cancer across different age groups in the UK across 2017-2019.

Age group	New cases per 100,000
20-24	19
25-29	47
30-34	134
35-39	273

Concurrently, Recent statistics from the Office of National Statistics show that the age at which women are currently having children is increasing. This leads to the prediction that women born in 2007 may birth most of their children after 30 years of age, and those born in 2025 are projected to birth their first child by age 36 [4]. This means that an increasing number of women of reproductive age may one day be  affected by the impact of colorectal cancer on their future reproductive outcomes.

The research

A recent study published by the Journal of the National Cancer Institute assessed reproductive outcomes for over 25,000 women affected by cancer and compared it with age-matched control participants. In this study, the most common cancer sites were the left colon and rectum.

Females with colorectal cancer experienced a more than three-fold increase in risk of pelvic inflammatory disease (PID). While less pronounced than in older women, the risk was found to be significantly elevated in those younger than 39, with radiation treatment specifically increasing the risk by 56%. PID-related inflammation can result in scarring of the reproductive tract, which increases the chances of experiencing infertility or ectopic pregnancy [5]. The likelihood of early menopause was ~75% higher in colorectal cancer patients and this probability more than doubled for those who received chemotherapy. Interestingly, in women under 39, there was a lower recorded risk of abnormal uterine bleeding [6]. This is likely a reflection of the absence of menstrual periods following treatment, or under-reporting, rather than a true positive outcome.

The study highlights that the adverse reproductive health outcomes following colorectal cancer treatment are a common and life-impacting risk for women of reproductive age. However, the mechanisms behind this are complex, ranging from the impact of radiotherapy and chemotherapy directly on ovarian and uterine tissue damage, to hormonal disruption and psychological factors. Therefore, providing holistic post-cancer care that considers reproductive health is multifactorial, requiring integrative thinking across oncology and gynecology. 

Where the system falls short

It is becoming clear that Younger women face disproportionate risks related to fertility loss and ovarian failure. These outcomes, and their consequences, persist for years beyond cancer treatment, underscoring a gap between mere cancer survival and care pathways that support true survivorship . Analyses of study reports from the last 5 years also show that while improving, gender inequalities in medical research are still present [7-9]. Such imbalances impact upon clinical practice guidelines and potentially ignore the specific concerns and consequences for female patients. 

Surveys have found that only a small minority of colorectal cancer patients recalled ever having a conversation with their care team about sexual health [10]. Surveys show that many oncologists cite a lack of training or comfort as key barriers to these discussions [11]. Evidence also suggests that these reservations are mutual, with patients often feeling that their symptoms are inevitable or inappropriate to discuss, leading to underreporting and lack of impact awareness among patient-facing healthcare professionals [12]. These factors underpin why  implementation is rare and under-prioritised, even where recommendations and guidelines do exist, such as those provided by The National Comprehensive Cancer Network® (NCCN®) [13-15].

What could change

Cancer care shouldn’t stop at survival.  Follow-up care often focuses on recurrence risk, but long-term effects like early menopause and fertility concerns can be just as life-altering. Reproductive health outcomes are measurable and treatable. However, we know that even when guidelines do consider fertility, there are still barriers to this being implemented in practice.

Early conversations

Discussions about fertility and menopause should happen before treatment begins, not as an afterthought. When clinicians raise these topics proactively, it removes the burden from patients to ask difficult questions during an already overwhelming time. Additionally, proactive conversation enables processes like egg retrieval to be considered before treatment begins.

Clear signposting

Many women live with symptoms simply because they don’t know whether help exists, or where to find it. Equally, clinicians are more likely to raise sensitive topics if they know that they don’t have to solve everything themselves, but that they can tap into a wider network of informed health care workers. Training should clearly outline such referral pathways.

Effective listening

Good communication isn’t just about asking the right questions, but also to create space for answers. Training should emphasise slowing down, allowing silence, and signalling that there is time to talk. Explicitly telling patients that reproductive effects are common, valid, and treatable empowers them to report symptoms earlier and more honestly.

Challenging language, culture and assumptions

Small changes in phrasing can make a big difference. Clinicians should be trained in inclusive, non-assumptive language. Training should explicitly challenge assumptions about age, parity, relationship status, or sexual orientation. Younger women may be assumed to “bounce back,” while older women may be assumed to no longer care about fertility or reproductive health. Naming these biases helps prevent uneven care.

Considering lived experience

The inclusion of real patient narratives in training may make the consequences of missed conversations more tangible. Hearing how a lack of information affects family planning, relationships, or mental health may help clinicians connect abstract risks to real-world outcomes. Becoming more aware of these perspectives may contribute to bridging the gap between clinical success and lived quality of life.

Cancer care should not end at remission. For women of reproductive age, survivorship must include the chance to understand, protect and plan for their future.

Header Image Source: Photo by Alicia Petresc on Unsplash

Edited by Dr Celia Snyman

References

1. American Cancer Society. (2026) ‘Cancer Facts & Figures’, Available at: https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/annual-cancer-facts-and-figures/2026/2026-cancer-facts-and-figures.pdf. (Accessed: 06/02/2026).
2. Wise, J. (2025) ‘Bowel cancer rising fastest in under 50s but study challenges “Cancer epidemic” in young adults’, BMJ, 391. doi:10.1136/bmj.r2225. 
3. Cancer Research UK. (2025) ‘Cancer statistics data hub’, Available at: https://crukcancerintelligence.shinyapps.io/CancerStatsDataHub/_w_60e14b1d5032410dbcf984d68c986f7f/?_inputs_&nav=%22Incidence%20Breakdowns%20and%20Trends%22&app_select_CancerSite=%22Bowel%22&app_select_Country=%22United%20Kingdom%22. (Accessed: 06/02/2026)
4. Office for National Statistics. (2025) ‘Childbearing for women born in different years, England and Wales: 2023’, Available at: https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/conceptionandfertilityrates/bulletins/childbearingforwomenbornindifferentyearsenglandandwales/2023. (Accessed: 06/02/2026)
5. Taylor, M. (2026) ‘Pelvic Inflammatory Disease: What It Is, How It Affects Fertility and When to Get Help’, Available at: https://www.whattoexpect.com/getting-pregnant/prepping-for-pregnancy/pelvic-inflammatory-disease-fertility/. (Accessed: 06/02/2026)
6. Oveisi, N., et al. (2025) ‘Sexual health outcomes after colorectal cancer diagnosis in females: a population-based cohort study’, Journal of the National Cancer Institute, 117(9). DOI: 10.1093/jnci/djaf120
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13. Eurekalert! (2024) ‘NCCN Policy Summit encourages conversation and action on sexual health and fertility issues faced by people with cancer’, Available at: https://www.eurekalert.org/news-releases/1043668? (Accessed: 06/02/2026)
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