Management of menopausal symptoms and ovarian function preservation in women with gynecological cancer

Abstract

Gynecological cancers affect a growing number of women globally, with approximately 1.3 million women diagnosed in 2018. Menopausal symptoms are a significant health concern after treatment for gynecological cancers and may result from oncologic treatments such as premenopausal bilateral oophorectomy, ovarian failure associated with chemotherapy or radiotherapy, and anti-estrogenic effects of maintenance endocrine therapy. Additionally, with the growing availability of testing for pathogenic gene variants such as BRCA1/2 and Lynch syndrome, there is an increasing number of women undergoing risk-reducing oophorectomy, which in most cases will be before age 45 years and will induce surgical menopause. Not all menopausal symptoms require treatment, but patients with cancer may experience more severe symptoms compared with women undergoing natural menopause. Moreover, there is increasing evidence of the long-term implications of early menopause, including bone loss, cognitive decline and increased cardiovascular risk. Systemic hormone therapy is well established as the most effective treatment for vasomotor symptoms and vaginal (topical) estrogen therapy is effective for genitourinary symptoms. However, the role of hormone receptors in many gynecological cancers and their treatment pose a challenge to the management of menopausal symptoms after cancer. Consequently, the use of menopausal hormone therapy in this setting can be difficult for clinicians to navigate and this article aims to provide current, comprehensive guidance for the use of menopausal hormone replacement therapy in women who have had, or are at risk of developing, gynecological cancer to assist with these treatment decisions.

Symptom burden survey and symptom clusters in patients with cervical cancer: a cross-sectional survey

“…Hot flashes and sweating seem to be specific symptoms of perimenopausal onset [ 24 ]. In addition, cancer-related treatments such as surgery, radiotherapy, and chemotherapy can cause ovarian failure and further affect hormone levels, which can lead to autonomic dysfunction and cause symptoms such as spontaneous perspiration, night sweats, and hot flushes [ 25 ]. Previous studies have identified this symptom cluster.…”

The menopause after cancer study (MACS) - A multimodal technology assisted intervention for the management of menopausal symptoms after cancer – Trial protocol of a phase II study

“…This is because breast cancer is the most common female cancer, it's treatment often involves the use of agents which may induce menopausal symptoms and MHT is generally contraindicated after breast cancer. We anticipate that there will be a smaller group of patients with gynaecological cancer as MHT can often be used safely after a diagnosis of gynaecological malignancy [ 42 ].…”

Using menopausal hormone therapy after a cancer diagnosis in Ireland

“…Nevertheless, this raises concerns for its use in women on aromatase inhibitors where the goal of therapy is to lower estrogen levels as much as possible [89,90]. A dearth of data exists for gynaecological cancers [91]. Given the reassuring observational data in breast cancer survivors, it is reasonable to offer vaginal estrogen where required even in those for whom systemic MHT is not recommended in discussion with the treating oncologist.…”