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What Is the Place of Hormone Replacement Therapy in Ovarian, Endometrial, and Breast Cancer?

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Abstract

Menopause is the last menstrual period and represents the end of reproductive life. Menopause is commonly associated with symptoms that may negatively impact on quality of life and function such as hot flushes and night sweats, vaginal dryness, and sleep disturbance. Hormone replacement therapy (HRT) effectively alleviates these climacteric symptoms but may have adverse consequences for some women. The role of HRT for the management of menopausal symptoms following breast cancer and gynecological malignancy has been controversial. Relatively few studies have addressed the safety of HRT in these circumstances to provide clinical guidance. HRT has also been implicated in the development or growth of some cancers. Unopposed estrogens increase the risk of endometrial cancer, as does combined HRT without an adequate dose or duration of progestagen exposure. Combined HRT increases the risk of breast cancer, but estrogen only HRT does not appear to increase breast cancer risk and may even be protective in some women. Sequential combined HRT may also increase the risk of ovarian cancer. In those with a history of gynecological cancer, limited evidence supports the safety of HRT. Following breast cancer, available evidence suggests that HRT may increase the risk of new or recurrent breast cancer and so HRT is avoided. The care of women with menopausal symptoms following breast or gynecological cancer should take a multidisciplinary approach.

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Authors and Affiliations

  1. Department of Gynecology, Leiden University Medical Center, Albinusdreef 2, 9600, Leiden, 2300RC, The Netherlands

    Inge T. A. Peters MD & J. Baptist Trimbos MD, PhD

  2. Obstetrics and Gynaecology, Royal Women’s Hospital, Flemington Rd., Parkville, Melbourne, VIC, 3052, Australia

    Fiona C. Brownfoot MBBS

  3. Obstetrics and Gynaecology, Royal Women’s Hospital and University of Melbourne, Flemington Rd, Parkville, Melbourne, VIC, 3052, Australia

    Martha Hickey MBChB, MRCOG, FRANZCOG, MD

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  1. Inge T. A. Peters MD
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  3. J. Baptist Trimbos MD, PhD
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Correspondence to Inge T. A. Peters MD .

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  1. UCL Cancer Institute, University College London, London, United Kingdom

    Jonathan A. Ledermann

  2. Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands

    Carien L. Creutzberg

  3. Royal Women’s Hospital, The University of Melbourne, Melbourne, Australia

    Michael A. Quinn

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Peters, I.T.A., Brownfoot, F.C., Trimbos, J.B., Hickey, M. (2014). What Is the Place of Hormone Replacement Therapy in Ovarian, Endometrial, and Breast Cancer?. In: Ledermann, J., Creutzberg, C., Quinn, M. (eds) Controversies in the Management of Gynecological Cancers. Springer, London. https://doi.org/10.1007/978-0-85729-910-9_23

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