Is menopausal hormone therapy safe in patients with a gynecologic cancer history?

Discussions around the management of menopausal symptoms after a gynecologic cancer diagnosis are an essential part of cancer management.1 A recent article in the Canadian Medical Association Journal (CMAJ) briefly summarizes five key points about the safety of menopausal hormone therapy in patients with a history of gynecologic cancer.2 1. Systemic and local menopausal hormone therapy can be considered after gynecologic cancer based on the hormonal receptivity of the cancer. Loss of ovarian function caused by treatment of gynecologic cancers can lead to severe and abrupt vasomotor symptoms. It can also increase the risk of cardiovascular disease, osteoporosis, and mood and cognition disorders. Hormone therapy with systemic (oral or transdermal) estrogen is recommended for vasomotor symptoms in patients with cancers that are not hormone sensitive, in consultation with the patient’s oncology team. Local (vaginal) hormone therapy options (ring, cream, tablet) can be considered in select patients.2. Systemic hormone therapy can be used safely in patients with an ovarian cancer that is not hormone sensitive (e.g., high-grade epithelial ovarian cancer).However, hormone therapy should not be prescribed for patients with hormone-sensitive cancers (e.g., low-grade serous, endometrioid or granulosa cell cancers).3. Hormone therapy can be used safely in patients with a history of cervical cancer.Estrogen-receptor positivity has no impact on the prognosis of cervical cancer. Progesterone should also be used for endometrial protection if the uterus is intact, as endometrial tissue can persist even after pelvic radiation or chemotherapy.4. Hormone therapy can be considered after early-stage (I–II) endometrial cancer; it does not appear to increase the risk of recurrence.However, data are insufficient on safety of hormone therapy in advanced-stage (III–IV) endometrial cancer or uterine sarcoma; hormone therapy is not recommended in these situations.5. Duration of therapy should be individualized.For younger patients, hormone therapy should generally continue until the average age of natural menopause (52 years). After this age, titrating to the lowest effective dose, changing to a nonoral route or stopping treatment can be discussed based on symptom severity, effectiveness of nonhormonal treatments and risks of cardiac disease and osteoporosis.References1. Donohoe F, O’Meara Y, Roberts A, et al. Using menopausal hormone therapy after a cancer diagnosis in Ireland. Irish J Med Sci 2023;192:45-55. (accessed January 9, 2024).2. Kotait M, Shea A, Nguyen JMV. Menopausal hormone therapy in patients with a history of gynecologic cancer. CMAJ 2023;195:E1721. (accessed January 9, 2024).

Is menopausal hormone therapy safe in patients with a gynecologic cancer history?

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