Hormonal Replacement Therapy after Gynaecological Cancer

Abstract

Thousands of women are treated each year for gynaecological cancers; many of these are already in menopause, while other younger patients will go into early menopause due to surgery, chemotherapy and/or radiotherapy to the pelvic region. The aim of this paper is to review the biological and clinical evidence in favour and against hormone replacement therapy (HRT) use after gynaecological cancers. With the exception of breast and endometrial cancer, there is no biological evidence that HRT may increase the recurrence risk. In women with previous endometrial cancer, HRT use is not supported by univocal and conclusive data to formulate specific recommendations, whereas most authors suggest that oestrogens may be used after adequate information about risks and benefits. The use of HRT in breast cancer patients is, at present, considered contra-indicated, even if results of clinical trials are not concordant. Therapeutic non-hormonal alternatives may be proposed to these patients.

Folic Acid Supplementation in Postmenopausal Women with Hot Flushes: Phase III Randomised Double-Blind Placebo-Controlled Trial

“…4,5 Furthermore, the use of HRT in breast cancer survivors is not recommended for fear of recurrence, and the management of vasomotor symptoms in these women has become a pressing clinical challenge due to improved survival rates such that good quality of life has become a benchmark for successful therapy. 6,7 The increased use of aromatase inhibitors leading to profound oestrogen deprivation 8 and the limited relief achieved by the currently available non-hormonal remedies 9 have made it necessary to search for a new effective and safe therapy.…”

Impact of post-operative hormone replacement therapy on life quality and prognosis in patients with ovarian malignancy

“…The ability of HRT to improve the quality of life for these patients remains controversial (23). In the present study, the EORTC and GMU-Gynae index results showed improved physical functions and emotional symptoms after HRT, and the general life quality in the HRT group was better than that in the non-HRT group.…”

Folic acid supplementation in postmenopausal women with hot flushes: phase III randomised double‐blind placebo‐controlled trial

“…coeliac or Crohn's disease; (3) chronic renal impairment; (4) chronic conditions mimicking climacteric presentation, e.g. poorly controlled hypertension, hyperglycaemia or thyroid instability; (5) pernicious anaemia due to vitamin B12 deficiency; (6) alcohol consumption >14 units per week; (7) phaeochromocytoma or carcinoid syndrome; (8) allergy to folic acid; taking prohibited medications unless the participant was willing and it was safe to discontinue doing so. In such cases, wash out periods were allowed before randomisation and were estimated based on the drug specifications published on MHRA website.…”

“…However, the publication of the Women Health Initiative trial in 2002 3 has dissuaded women from taking HRT due to concerns over potential adverse effects 4,5 . Furthermore, the use of HRT in breast cancer survivors is not recommended for fear of recurrence, and the management of vasomotor symptoms in these women has become a pressing clinical challenge due to improved survival rates such that good quality of life has become a benchmark for successful therapy 6,7 . The increased use of aromatase inhibitors leading to profound oestrogen deprivation 8 and the limited relief achieved by the currently available non‐hormonal remedies 9 have made it necessary to search for a new effective and safe therapy.…”