Hormone replacement therapy following treatment of gynaecological malignancies

Abstract

Key content Approximately 21 000 women in the UK were diagnosed with a gynaecological malignancy in 2015; although most of these malignancies occurred in postmenopausal women, 30–40% present in premenopausal or perimenopausal women. Management typically involves surgery and/or chemotherapy and/or radiotherapy, which in younger women may result in an induced menopause. Many women struggle with both the immediate symptoms and the long‐term consequences of estrogen deficiency, all of which are debilitating and compromise the quality and quantity of life, in addition to the cancer diagnosis and treatment. These patients represent a complex group and most units in the UK do not have easy access to menopause specialists. Gynaecologists may be reluctant to prescribe hormone replacement therapy (HRT) to these women; clinicians involved in the care of these women must appreciate when HRT is and is not contraindicated. Learning objectives To understand the safety of HRT in women who have undergone treatment for endometrial, ovarian, cervical, vulval or vaginal malignancies, with particular emphasis on the type, stage and grade of cancer. To establish an evidence‐based approach to the management of menopausal symptoms using HRT in women who have previously been treated for a gynaecological malignancy. To appreciate the role of non‐hormonal alternatives to HRT in these women. Ethical issues How to balance the known benefits of HRT against the potential risks, when evidence is limited in women who have undergone treatment for a gynaecological malignancy.