Hormonal Replacement Therapy After Neoplasia Treatment

Abstract

Post-menopausal hormonal therapy (HT) may help to improve quality of life and prevent long-term consequences of estrogen deficiency. The use of HT in postmenopausal cancer survivors is controversial, particularly for those women having survived hormone-dependent tumors, like breast or gynecological cancers. Endometrial cancer is the most frequent gynecological cancer. The limited data of the literature on women having suffered from endometrial cancer do not show an increased recurrence or death with HT use, but guidelines do not yet indicate the generalized use of HT in these women. HT should be avoided in uterine sarcomas. Breast cancer survivors suffer from climacteric symptoms after menopause or as a consequence of adjuvant hormonal anti-estrogen treatment. The risk of cancer recurrence with HT is uncertain: the two randomized prospective controlled trials were prematurely stopped. Actually, clinical guidelines contraindicate HT use in breast cancer survivors. New therapeutic approach for selected symptoms such as ospemifene (a SERM molecule) can be promising. There is no strong evidence for denying HT to patients treated for ovarian cancer, independently of disease stage. Even for women with an endometrioid carcinoma of the ovary, an estrogen-sensitive tumor, evidence indicates no harm from HT. More controversial is the use of HT after granulosa cell tumors. HT can be administered in women treated for squamous cancers of the cervix and the vulva or vaginal neoplasm. The approach to cervical adenocarcinoma should follow that of endometrial cancer. In conclusion, HT is not contraindicated in all women with a history of gynecological cancer, but its use is dependent on the type of cancer the woman has suffered from.