Hormonal management of menopausal symptoms in women with a history of gynecologic malignancy

Abstract

Objective: The aim of the study was to review the role of hormone therapy in menopausal patients with breast cancer and gynecologic malignancies. Methods: We searched MEDLINE (via PubMed) using a combination of keywords and database-specific subject headings for the following concepts: menopause, hormone therapy, and cancer. Editorials, letters, case reports, and comments were excluded, as were non-English articles. Additional references were identified by hand-searching bibliographies of included articles. The searches yielded a total of 1,484 citations. All citations were imported into EndNote X9, where they were screened by the authors. Results: In breast cancer survivors, systemic hormone therapy is not recommended, whereas local low-dose estrogen therapy may be considered after discussion with the patient's oncologist. Among endometrial cancer survivors, hormone therapy is considered safe in low-risk cancers but should be avoided in high-risk subtypes. For survivors of epithelial ovarian cancer and cervical cancer, hormone therapy can be considered, but should be avoided in women with estrogen-sensitive histologic subtypes. Conclusions: The risks of hormone therapy should be assessed on an individual basis, with consideration of age, type of hormone therapy, dose, duration of use, regimen, route, and prior exposure. Systemic hormone therapy is not recommended in breast cancer survivors, whereas vaginal low-dose estrogen appears safe. Hormone therapy may be used by endometrial, cervical, and ovarian cancer survivors with low-risk, non-estrogen-receptor–positive subtypes. Video Summary: http://links.lww.com/MENO/A516.

The 2022 hormone therapy position statement of The North American Menopause Society

“…Although hormone therapy is generally contraindicated in women with estrogen-responsive cancers, hormone therapy may be used to treat bothersome menopause symptoms in women with low-grade, Stage I endometrial cancer after hysterectomy. Meta-analyses of retrospective studies, with one RCT, do not identify an AE on the risk of recurrence or survival in these cases 303-306 . A woman’s oncologist should be included in shared decision-making.…”

The Genitourinary Syndrome of Menopause: An Overview of the Recent Data

“…In cases with a history of estrogensensitive tumors, such as breast or endometrial cancer, any hormonal therapy should be used with caution; the risk/benefit ratio needs to be individualized and in coordination with an oncologist [19]. Hormonal therapy risks should be evaluated thoroughly and factors such as age, duration of use, dose, type of treatment, route, histologic type of malignancy, and prior exposure should be considered before the prescription of such regimen in survivors of gynecological cancer [29]. Breast cancer is a hormone-sensitive carcinoma in many cases; hence, systemic hormonal therapy is not usually recommended for women with breast cancer [29,30].…”

“…Hormonal therapy risks should be evaluated thoroughly and factors such as age, duration of use, dose, type of treatment, route, histologic type of malignancy, and prior exposure should be considered before the prescription of such regimen in survivors of gynecological cancer [29]. Breast cancer is a hormone-sensitive carcinoma in many cases; hence, systemic hormonal therapy is not usually recommended for women with breast cancer [29,30]. As far as endometrial cancer survivors are concerned, the data, although limited, suggest that hormonal therapy is considered relatively safe in low-risk subtypes (i.e., earlystage, low-grade, or type I), but should not be employed in high-risk types [29,31].…”

“…Breast cancer is a hormone-sensitive carcinoma in many cases; hence, systemic hormonal therapy is not usually recommended for women with breast cancer [29,30]. As far as endometrial cancer survivors are concerned, the data, although limited, suggest that hormonal therapy is considered relatively safe in low-risk subtypes (i.e., earlystage, low-grade, or type I), but should not be employed in high-risk types [29,31]. Similarly, in survivors of epithelial ovarian cancer, hormonal treatment could be considered in selected cases, since evidence suggests a neutral effect in survival; but it should be avoided in certain histologic types, such as advanced serous and endometrioid and other estrogen-sensitive tumor types [29][30][31].…”

Endokrine Folgen einer Tumortherapie

“…Möglich ist hier lediglich eine Lokaltherapie mit niedrigen Dosen. Patientinnen mit vorangegangenem Endometrium-, Zervix-oder Ovarialkarzinom scheinen bei einer Estrogen-Therapie keiner Gefahr ausgesetzt, solan- ge sie sich nicht in einer High-Risk-Gruppe befinden [15].…”