Vaginal estrogen use for genitourinary symptoms in women with a history of uterine, cervical, or ovarian carcinoma

Abstract

ObjectiveMenopausal symptoms may adversely affect quality of life and health in women diagnosed with a gynecologic malignancy. The aim of this study was to determine the incidence of adverse outcomes, including cancer recurrence, venous thromboembolism, and secondary malignancies, among patients with a history of endometrial, ovarian, or cervical cancer prescribed vaginal estrogen for genitourinary syndrome of menopause.MethodsA retrospective cohort study was performed including women who were diagnosed with endometrial, ovarian, or cervical cancer from January 1, 1991 to December 31, 2017 and subsequently treated with vaginal estrogen for genitourinary syndrome of menopause. Patients were included if not undergoing active cancer treatment and were disease-free based on most recent cancer surveillance visit with physical exam and/or imaging. Demographics, oncologic variables, estrogen use, and adverse outcomes were recorded. Descriptive statistics and univariate analysis were performed.ResultsOf 244 women who received vaginal estrogen, 52% (n=127) had a history of endometrial, 25.4% (n=62) cervical, 18.9% (n=46) ovarian cancer, and 3.7% (n=9) low malignant potential tumors. The mean age and body mass index were 55.5±12.5 years and 29.2±8.6 mg/kg2, respectively. With a median follow-up of 80.2 months, the incidence of recurrence for endometrial, ovarian, and cervical cancer was 7.1% (n=9), 18.2% (n=10), and 9.7% (n=6), respectively. In patients with endometrial cancer who recurred, the incidence was 2.4% (n=3) for stage I/II and 4.7% (n=6) for stage III/IV disease. Similarly, recurrence rates for ovarian cancer were 4.3% (n=2) for stage I/II and 17.4% (n=8) for stage III/IV disease. All cervical cancer recurrences were in patients with stage I/II disease. Adverse outcomes including breast cancer (1.6%, n=4), secondary malignancy (2.5%, n=6), and venous thromboembolism (2.5%, n=6) were rare.ConclusionIn women with a history of endometrial, ovarian, or cervical cancer prescribed vaginal estrogen use for genitourinary syndrome of menopause, adverse outcomes, including recurrence and thromboembolic events, are infrequent. Vaginal estrogen may be considered safe in gynecologic cancer survivors.

Benefits of a Multidisciplinary Women’s Sexual Health Clinic in the Management of Sexual and Menopausal Symptoms After Pelvic Radiotherapy

“…5,32,33 Furthermore, a recent study consisting of uterine, cervical, and ovarian cancer patients has shown the safety of vaginal estrogen in these patients, with low risk of recurrence and thromboembolic events. 26 In line with these findings, of the 57 women treated with local or systemic HRT in our study, only 4 women had recurrences. However, fear of HRT in the setting of cancer remains a barrier to acceptance of HRT and was expressed 13 patients in our study, reflecting the importance of patient-provider communication regarding the risks and benefits of HRT.…”

“…While there are some systematic and prospective data regarding interventions for sexual dysfunction among cancer populations generally, 23,24 there is little data available to guide this discussion specifically within the realm of pelvic malignancies. While prior studies have focused on the prevalence of sexual changes after PRT [7][8][9][10][13][14][15][16]25 or safety of interventions, 2,6,26 few have focused on efficacy of interventions in improving symptoms. Therefore, in this study, we aimed to describe not only the sexual and menopausal symptoms among female patients with gynecologic and lower gastrointestinal malignancies who underwent PRT, but also treatment patterns and outcomes of patients who were treated in a multidisciplinary program specifically dedicated to these concerns.…”

Individual Benefits and Risks of Intravaginal Estrogen and Systemic Testosterone in the Management of Women in the Menopause, With a Discussion of Any Associated Risks for Cancer Development

“…By extrapolation, it is likely that low-dose intravaginal estrogen is also safe for these women. More recently, a retrospective cohort study concluded that intravaginal estrogen does not appear to increase recurrence risk beyond baseline for women with both early and advanced disease 71 . These findings provide some reassurance about intravaginal low-dose estrogen use in women with either early-stage or even higher-stage endometrial cancers suffering with GSM.…”

Topical estrogens and non-hormonal preparations for postmenopausal vulvovaginal atrophy: An EMAS clinical guide

“…Although data are limited, there is no evidence of increased risk of endometrial cancer recurrence with topical estrogen [60,63]. In contrast, uterine sarcomas may be hormone dependent but there are no clinical trial data to inform practice in women whose tumors are steroid receptor negative [60].…”