Safety of hormone replacement therapy in gynaecological cancer survivors

Abstract

Therapy for endometrial, ovarian and cervical cancer in young women can cause sudden onset of intense menopausal symptoms, such as hot flushes, emotional disorders and sexual dysfunction. In order to overcome these unpleasant and sometimes severe symptoms, hormone replacement therapy (HRT) has proven to be very effective. However, its safety remains controversial. We reviewed English literature and examined whether administration of HRT in this specific population is related with more recurrences and worse prognosis. Current scientific data, comprising mainly retrospective studies, suggest that recurrence rates and survival are comparable between HRT users and non-users. However, large randomised trials are missing and definitive conclusions cannot be drawn. Gynaecological cancer survivors using HRT, although they seem to have little if any risk for recurrence, should be correctly informed about the lack of strong evidence.

Associations among menopausal symptoms, sleep and fatigue in Taiwanese women with endometrial cancer

“…However, only 13%–30% of physicians were willing to prescribe HRT for women with moderate‐to‐severe menopausal symptoms (Hancke et al., ) or endometrial cancer survivors (Vavilis et al., ). Despite the data showing that the risk of cancer recurrence or death does not differ significantly in women who use and do not use HRT, healthcare providers are still concerned about the long‐term risk of cancer recurrence and overall survival because the positive study results might be due to patients’ early disease stage and radical removal of the cancer (Biliatis et al., ). Providers tend to believe that receiving HRT might stimulate disease recurrence in women with advanced oestrogen‐dependent disease that was insufficiently managed (Biliatis et al., ).…”

Hormone replacement therapy after treatment for a gynaecological malignancy

“…There are no trials evaluating the use of HRT in these patients. It is believed that HRT may be used safely for many germ cell tumours but a small subset of germ cell tumours may secrete hormones (often testosterone) and treatment of menopausal symptoms with HRT should therefore be avoided and alternatives explored [50].…”

“…At diagnosis, more than 75% of women have advanced stage disease and their 5-year survival is poor, not exceeding 45%. For this reason, focus upon quality of life after treatment may become increasingly important for some women and relief of menopausal symptoms may for some outweigh the fear of recurrence [50].…”

“…A proportion of sarcomas, from each subtype, have been shown to express progesterone receptor or oestrogen receptor and may, therefore, be amenable to treatment with hormone therapies [47][48][49] so HRT should be avoided [50,51].…”

Postoperative hormone replacement therapy for epithelial ovarian cancer patients: A systematic review and meta-analysis

“…Many clinicians remain reluctant to prescribe HRT for these patients due to the fear of ovarian cancer relapse or the development of breast cancer [8]. To date, studies on HRT use after surgery for EOC are limited, even reaching seemingly contradictory conclusions [9]. It is difficult for EOC survivors and their physicians to weigh the risks and benefits without estimates of the effect of HRT on EOC prognosis and recurrence.…”