Menopause hormone treatment after cancer

Abstract

Regular improvement in survival of women after treatment for cancer has been reached in these last years. Menopause hormone therapy (MHT) remains the most efficient treatment to alleviate climacteric symptoms and improve quality of life in symptomatic women. The long-term effects of estrogen deficiency can be, at least partially, prevented by MHT. However, using MHT in an oncologic context can be associated with contraindications. Patients who have experienced breast cancer frequently face severe climacteric symptoms, but results from randomized trials are not in favor of using MHT in these women. Three randomized trials are available in women treated by MHT after ovarian cancer, and report better survival rates in the active group of treatment, suggesting that, at least in serous high-grade ovarian carcinoma, MHT could be allowed. No robust data are available for MHT after endometrial carcinoma. According to various guidelines, MHT could be possible in low grades with good prognosis. Progestogen, however, is not contraindicated and can help to alleviate climacteric symptoms. Squamous cell cervical carcinoma is not hormone-dependent and therefore patients can be treated with MHT without restrictions, whereas cervical adenocarcinoma is likely to be estrogen-dependent, despite lack of robust data, and thus only progesterone or progestin might be potentially used. It is possible that, in future, better molecular characterization of genomic profiles of various cancers may allow MHT to be used with some patients.

摘要

女性在接受癌症治疗后的生存率在最近几年已经得到了改善。绝经激素治疗(MHT)仍然是缓解更年期症状和改善有症状妇女生活质量的最有效的治疗方法。MHT可以至少部分地预防雌激素缺乏的长期影响。然而, 在肿瘤学背景下使用MHT可能有禁忌症。经历过乳腺癌的患者经常面临严重的更年期症状, 但随机临床试验结果不赞成在这些乳腺癌妇女使用MHT。在卵巢癌后接受MHT治疗的女性中, 有3个随机临床试验可用, 并报道了在有效治疗组中有更好的生存率, 这表明, 至少在浆液性高级别卵巢癌中, MHT是允许的。子宫内膜癌术后没有可靠的数据证实可用MHT。根据不同的指南, MHT在预后良好的低分级的子宫内膜癌是可能使用的。黄体酮不是禁忌证, 可以帮助缓解更年期症状。鳞状细胞宫颈癌不是激素依赖性的, 因此患者可以不受限制地使用MHT治疗, 而宫颈腺癌可能是雌激素依赖性的, 尽管缺乏强有力的数据, 因此只有孕酮或黄体酮可能被使用。在未来, 对各种癌症基因组谱的更好的分子特性的研究可能使MHT用于这些特殊患者。

Keywords:

• Breast cancer
• ovarian cancer
• endometrial cancer
• uterine sarcoma
• cervical cancer

Acknowledgements

Thanks to Hedley Hamilton for editing the English.

Potential conflict of interest

Punctual advisory board of dydrogesterone in April 2021.

Source of funding

Nil.

Notes

1 Level of evidence and grades for recommendations according to the European Society for Medical Oncology.