Trends in use of estrogen replacement therapy for premenopausal women with gynecologic cancer after surgical menopause (372)

Abstract

<b>Objectives:</b> Estrogen replacement therapy (ERT) for pre-menopau- sal women who undergo oophorectomy and surgical menopause with gynecologic cancers remains controversial. ERT may not only prevent menopausal symptoms but also decrease the risk of longterm sequelae of estrogen deprivation, including osteoporosis and cardiovascular disease. We examined trends in the use of ERT among pre-menopausal women with gynecologic cancer who underwent bilateral oophorectomy. <b>Methods:</b> The IBM Watson Health MarketScan Database was used to identify women <50 years of age with gynecologic cancer who underwent bilateral salpingo-oophorectomy (BSO) from 2008-2019. ERT was defined as any prescription of estrogen with or without progesterone filled from six weeks prior to BSO to within three years of BSO. The cumulative rates of ERT use over time, time to initiation of ERT, and duration of ERT were examined. Performance of testing associated with estrogen deprivation in young women, including bone mineral density testing, lipid screening, and diabetes screening, was examined. Cumulative rates of ERT stratified by age groups were analyzed using Kaplan-Meier analyses. A multivariable log-linear regression model was developed to examine factors associated with ERT use. <b>Results:</b> A total of 4,972 women were identified. Overall, 1,952 (38.5%) women received ERT and 3,060 (61.5%) were not treated with ERT. The rate of ERT declined year over year from a peak of 45.9% in 2008 to 17.7% in 2019. Patients aged 18-29 years had the highest rate of ERT (62.9%) use, and those aged 45-50 years had the lowest rate (31.7%). The median time to initiation of ERT was 0.4 months after BSO (IQR: 0.1-2.5 months), and ERT was used for a median of 3.4 months (IQR: 1.0-10.3 months). The cumulative rate of ERT use at 12, 24, 36 months after BSO was 36.3%, 38.9%, and 40.3%, respectively. ERT was utilized in 30.4% of women with uterine cancer, 55.7% of women with cervical cancer, and 34.3% with ovarian cancer. In a multivariable model, younger age, Medicaid recipient, concurrent hysterectomy with BSO, and diagnosis of cervical cancer were associated with higher ERT rates. By the end of 36 months of BSO, bone mineral density testing was performed in 16.6% of women who received ERT compared to 16.9% not treated with ERT, while lipid testing was performed in 70.7% and 73.0% of women in these groups, respectively. Fig. 1 <b>Conclusions:</b> The rate of ERT after surgical menopause among premenopausal women with gynecologic malignancies has declined substantially. Testing for adverse events associated with estrogen deprivation is uncommon.