Menopause, hormone replacement and gynaecological cancers

Abstract

Approximately 18,000 women are diagnosed with a gynaecological cancer in the UK each year. Predisposing risk factors for some of these gynaecological cancers include an early menarche/late menopause and hormone replacement therapy (HRT). Furthermore, treatment of gynaecological malignancies often induces an iatrogenic menopause, which may be more severe than a natural onset. HRT is an extremely effective treatment that may dramatically improve physical and psychological symptoms and ultimately quality of life in patients with cancer. However, the safety of using HRT in patients with gynaecological cancer is a controversial issue and not entirely clear. The main concern is the theoretical risk of the stimulation of residual cancer cells by estrogen replacement. The review of the evidence in this article found that for most gynaecological cancers this hypothesis was not proven. No study to date has found HRT to have a detrimental effect on survival in patients with early stage endometrial cancer, epithelial ovarian cancer, cervical cancer and vulval tumours. HRT is only an absolute contraindication in low-grade endometrial stromal sarcomas and is best avoided in granulosa cell ovarian tumours. Therefore, HRT should not be withheld in the majority of patients with gynaecological cancer. If quality of life is being adversely affected by symptoms of the menopause, then patients with cancer should be counselled regarding the known risks and benefits of HRT to enable them to make an informed decision on their treatment.

Age at menarche and age at natural menopause in East Asian women: a genome-wide association study

“…Menarche and menopause out of the common range have been associated with risk for various diseases, including breast cancer (Velie et al 2005;Vogel 2008), endometrial and ovarian cancer (Hinds and Price 2010;Cramer 2012), cardiovascular disease (Cui et al 2006), and osteoporosis (Qiu et al 2013;Parker et al 2014). It has been well recognized that genetic makeup influences both AM (Sharma 2002;Anderson et al 2008) and ANM (de Bruin et al 2001;Murabito et al 2005;Morris et al 2011).…”

Iatrogenic Menopause After Treatment for Cervical Cancer

“…Women who have undergone premature ovarian failure (POF) due to oncological treatment are subject to a sudden onset of menopause which is often more severe than physiological menopause [3], with the onset of symptoms within days of surgery and within 12 weeks after starting radiotherapy. The stress of undergoing a cancer diagnosis can also cause menopausal symptoms to become more severe [4].…”

Should we give up hormone treatment in menopause?

“…It was emphasized that endometrium cancer risk would increase with estrogen-only regimens free from the body mass index, and thus combined estrogen/ progesterone therapy should be preferred (14) . In another study, risk of recurrence based on HT usage was evaluated in patients who were followed up due to endometrium cancer, and it was stated that HT usage in those women particularly having stage 1 and 2 endometrium cancer would not cause a risk increase for the recurrence (15,16) . The common result is; HT shall not cause an increased risk in recurrence of early stage female genital organ malignancies.…”

“…However, HT is clearly contraindicated due to increased risk of Should we give up hormone treatment in menopause? recurrence particularly on women who are followed up due to endometrial stromal sarcoma (16) .…”