The long-term effects of the Holocaust on the reproductive function of female survivors.

STUDY OBJECTIVE

The aim of this study was to evaluate the effect of internment in the German concentration camps during World War II on menstrual function; future fertility; and, ultimately, on gynecologic diseases or future surgery needs.

SUBJECTS

Five hundred eighty Hungarian female survivors of concentration camps.

INTERVENTION

Menstrual and reproductive histories of the women were obtained and analyzed, comparing histories and events from pre-internment, internment, and post-internment periods of time.

MEASUREMENTS AND MAIN RESULTS

The mean age of the survivors at the time of internment was 23.4 +/- 8.0 years (95% CI 22.7-24.1). Amenorrhea occurred in 94.8% of the women during encampment (95% CI 92.7%-96.5%), with 82.4% experiencing cessation of menses immediately after internment (95% CI 76.9%-85.6%). Only 0.6% of women (95% CI 0.12%-1.63%) menstruated longer than 4 months after internment. After liberation, all but 8.9% of the women resumed menstruation within the first year (95% CI 88.4%-93.3%). Fecundity subsequent to liberation was not significantly affected by the imprisonment nor was there a significant increase in spontaneous abortion, ectopic pregnancies, stillbirths, or other pregnancy complications. Additionally, there was no evidence of impact on the subsequent frequency of gynecologic diseases or surgical procedures.

CONCLUSIONS

Imprisonment in German concentration camps during the Holocaust resulted in enormous emotional and psychological changes in the survivors. In addition, this study reveals abrupt changes in short-term menstrual function but little long-term physical damage to reproductive function.