Ovarian Hormone Replacement Therapy in Gynecological Cancer Survivors

Abstract

The number of survivors after gynecological cancer is increasing. In order to improve their quality of life, the need was felt to review the present status of ovarian steroid hormone replacement therapy (HRT) in them. The purpose was to examine the published literature on menopause management in them and highlight the risks and benefits. The literature search on menopause management in cancer survivors was performed. The research and review articles in English language on the subject that were available and accessible were reviewed. And the recommendations and opinions were presented as working guidelines. Treatment of some of gynecological cancers and the breast cancer results in abrupt loss of ovarian function and severe menopausal symptoms. Use of HRT in women with a genetic predisposition for or development of a gynecological malignancy suggests no proven adverse oncologic effects as a result of short-term use. The main concerns are the potential stimulation of residual cancer and the induction of new hormone-dependent disease. The majority of the most common gynecological malignancies like squamous cell carcinomas of the cervix, serous papillary epithelial ovarian carcinomas and squamous cell carcinomas of the vulva are not estrogen dependent. HRT is not shown to adversely affect the outcome in patients after treatment for hormone-sensitive cancers like early-stage endometrioid adenocarcinomas of the endometrium. In cases with low-grade endometrial stromal sarcomas, it is an absolute contraindication. The option needs to be discussed individually with the survivor providing unbiased information.