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Hormone therapy (HT) in women with gynecologic cancers and in women at high risk for developing a gynecologic cancer: A Society of Gynecologic Oncology (SGO) clinical practice statement

This practice statement has been endorsed by The North American Menopause Society
Published:February 14, 2020DOI:https://doi.org/10.1016/j.ygyno.2020.01.035

      Highlights

      • Treatment or prevention of gynecologic cancer often results in induced menopause significantly impacting quality of life.
      • Hormone therapy is underutilized in in these settings despite more severe symptoms with induced menopause.
      • The risk/benefit profile of HT is favorable in most EOC, early stage endometrial, and cervical cancer.
      • HT is not recommended in women with advanced EC, uterine sarcoma, endometrioid or low grade serous ovarian cancer.
      • Lynch syndrome patients and BRCA mutation carriers without history of breast cancer may also use HT to improve QOL.
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      References

        • Ibeanu O.
        • et al.
        Hormone replacement therapy in gynecologic cancer survivors: why not?.
        Gynecol. Oncol. 2011; 122: 447-454
        • Del Carmen M.G.
        • Rice L.W.
        Management of menopausal symptoms in women with gynecologic cancers.
        Gynecol. Oncol. 2017; 146: 427-435
        • Committee on Practice, B.-G
        • O. Society of Gynecologic
        ACOG practice bulletin no. 147: Lynch syndrome.
        Obstet. Gynecol. 2014; 124: 1042-1054
        • Committee on Practice Bulletins-Gynecology
        C.o.G.S.o.G.O., practice bulletin no 182: hereditary breast and ovarian cancer syndrome.
        Obstet. Gynecol. 2017; 130: e110-e126
      1. NCCN guidelines version 3.2019 genetic/familial high-risk assessment: breast and ovarian.
        • The, N.H.T.P.S.A.P
        The 2017 hormone therapy position statement of The North American Menopause Society.
        Menopause. 2017; 24: 728-753
        • Hinds L.
        • Price J.
        Menopause, hormone replacement and gynaecological cancers.
        Menopause Int. 2010; 16: 89-93
        • Castelo-Branco C.
        • et al.
        Effects of oophorectomy and hormone replacement therapy on pituitary-gonadal function.
        Maturitas. 1993; 17: 101-111
        • Nelson H.D.
        Menopause.
        Lancet. 2008; 371: 760-770
        • Portman D.J.
        • Gass M.L.
        • P. Vulvovaginal Atrophy Terminology Consensus Conference
        Genitourinary syndrome of menopause: new terminology for vulvovaginal atrophy from the International Society for the Study of Women’s Sexual Health and the North American Menopause Society.
        Menopause. 2014; 21: 1063-1068
        • Faubion S.S.
        • et al.
        Long-term health consequences of premature or early menopause and considerations for management.
        Climacteric. 2015; 18: 483-491
        • Popat V.B.
        • et al.
        Bone mineral density in young women with primary ovarian insufficiency: results of a three-year randomized controlled trial of physiological transdermal estradiol and testosterone replacement.
        J. Clin. Endocrinol. Metab. 2014; 99: 3418-3426
        • Maclennan A.H.
        • et al.
        Oral oestrogen and combined oestrogen/progestogen therapy versus placebo for hot flushes.
        Cochrane Database Syst. Rev. 2004; 4: CD002978
        • Rahn D.D.
        • et al.
        Vaginal estrogen for genitourinary syndrome of menopause: a systematic review.
        Obstet. Gynecol. 2014; 124: 1147-1156
        • Lethaby A.
        • Ayeleke R.O.
        • Roberts H.
        Local oestrogen for vaginal atrophy in postmenopausal women.
        Cochrane Database Syst. Rev. 2016; 8: CD001500
        • Sarrel P.M.
        • Sullivan S.D.
        • Nelson L.M.
        Hormone replacement therapy in young women with surgical primary ovarian insufficiency.
        Fertil. Steril. 2016; 106: 1580-1587
        • Hancke K.
        • et al.
        Estrogen replacement therapy after endometrial cancer: a survey of physicians’ prescribing practice.
        Climacteric. 2010; 13: 271-277
        • Barakat R.R.
        • et al.
        Randomized double-blind trial of estrogen replacement therapy versus placebo in stage I or II endometrial cancer: a Gynecologic Oncology Group Study.
        J. Clin. Oncol. 2006; 24: 587-592
        • Shim S.H.
        • Lee S.J.
        • Kim S.N.
        Effects of hormone replacement therapy on the rate of recurrence in endometrial cancer survivors: a meta-analysis.
        Eur. J. Cancer. 2014; 50: 1628-1637
        • Edey K.A.
        • Rundle S.
        • Hickey M.
        Hormone replacement therapy for women previously treated for endometrial cancer.
        Cochrane Database Syst. Rev. 2018; 5: CD008830
        • Wright J.D.
        • et al.
        Safety of ovarian preservation in premenopausal women with endometrial cancer.
        J. Clin. Oncol. 2009; 27: 1214-1219
        • George S.
        • et al.
        Phase 2 trial of aromatase inhibition with letrozole in patients with uterine leiomyosarcomas expressing estrogen and/or progesterone receptors.
        Cancer. 2014; 120: 738-743
        • Yue X.
        • et al.
        Expression of steroid and xenobiotic receptor in uterine carcinosarcoma, leiomyosarcoma and endometrial stromal sarcoma.
        Oncol. Lett. 2013; 5: 835-839
        • Mascarenhas C.
        • et al.
        Use of hormone replacement therapy before and after ovarian cancer diagnosis and ovarian cancer survival.
        Int. J. Cancer. 2006; 119: 2907-2915
        • Guidozzi F.
        • Daponte A.
        Estrogen replacement therapy for ovarian carcinoma survivors: a randomized controlled trial.
        Cancer. 1999; 86: 1013-1018
        • Ursic-Vrscaj M.
        • Bebar S.
        • Zakelj M.P.
        Hormone replacement therapy after invasive ovarian serous cystadenocarcinoma treatment: the effect on survival.
        Menopause. 2001; 8: 70-75
        • Eeles R.A.
        • et al.
        Adjuvant hormone therapy may improve survival in epithelial ovarian cancer: results of the AHT randomized trial.
        J. Clin. Oncol. 2015; 33: 4138-4144
        • Li D.
        • Ding C.Y.
        • Qiu L.H.
        Postoperative hormone replacement therapy for epithelial ovarian cancer patients: a systematic review and meta-analysis.
        Gynecol. Oncol. 2015; 139: 355-362
        • Gershenson D.M.
        • et al.
        Hormonal maintenance therapy for women with low-grade serous cancer of the ovary or peritoneum.
        J. Clin. Oncol. 2017; 35: 1103-1111
        • Gershenson D.M.
        • et al.
        Hormonal therapy for recurrent low-grade serous carcinoma of the ovary or peritoneum.
        Gynecol. Oncol. 2012; 125: 661-666
        • Rauh L.A.
        • Pannone A.F.
        • Cantrell L.A.
        Hormone replacement therapy after treatment for cervical cancer: are we adhering to standard of care?.
        Gynecol. Oncol. 2017; 147: 597-600
        • Martin J.D.
        • et al.
        The influence of estrogen and progesterone receptors on survival in patients with carcinoma of the uterine cervix.
        Gynecol. Oncol. 1986; 23: 329-335
        • Tabata M.
        • et al.
        Incidence of ovarian metastasis in patients with cancer of the uterine cervix.
        Gynecol. Oncol. 1987; 28: 255-261
        • Ploch E.
        Hormonal replacement therapy in patients after cervical cancer treatment.
        Gynecol. Oncol. 1987; 26: 169-177
        • Pickar J.H.
        • et al.
        Endometrial effects of a tissue selective estrogen complex containing bazedoxifene/conjugated estrogens as a menopausal therapy.
        Fertil. Steril. 2009; 92: 1018-1024
        • Singh P.
        • Oehler M.K.
        Hormone replacement after gynaecological cancer.
        Maturitas. 2010; 65: 190-197
        • NCCN Clinical Practice Guidelines in Oncology
        Genetic/Familial High-risk Assessment: Breast and Ovarian.
        (Version 1. Available at)
        • Parker W.H.
        • et al.
        Ovarian conservation at the time of hysterectomy and long-term health outcomes in the nurses’ health study.
        Obstet. Gynecol. 2009; 113: 1027-1037
        • Jacoby V.L.
        • et al.
        Oophorectomy vs ovarian conservation with hysterectomy: cardiovascular disease, hip fracture, and cancer in the Women’s Health Initiative Observational Study.
        Arch. Intern. Med. 2011; 171: 760-768
        • Rocca W.A.
        • et al.
        Survival patterns after oophorectomy in premenopausal women: a population-based cohort study.
        Lancet Oncol. 2006; 7: 821-828
        • Rebbeck T.R.
        • et al.
        Effect of short-term hormone replacement therapy on breast cancer risk reduction after bilateral prophylactic oophorectomy in BRCA1 and BRCA2 mutation carriers: the PROSE Study Group.
        J. Clin. Oncol. 2005; 23: 7804-7810
        • Kotsopoulos J.
        • et al.
        Hormone replacement therapy after oophorectomy and breast cancer risk among BRCA1 mutation carriers.
        JAMA Oncol. 2018; 4: 1059-1065
        • Armstrong K.
        • et al.
        Hormone replacement therapy and life expectancy after prophylactic oophorectomy in women with BRCA1/2 mutations: a decision analysis.
        J. Clin. Oncol. 2004; 22: 1045-1054
        • Marchetti C.
        • et al.
        Hormone therapy in oophorectomized BRCA1/2 mutation carriers.
        Menopause. 2014; 21: 763-768
        • Kotsopoulos J.
        • et al.
        Hormone replacement therapy and the risk of ovarian cancer in BRCA1 and BRCA2 mutation carriers.
        Gynecol. Oncol. 2006; 100: 83-88
        • Chlebowski R.T.
        • Aragaki A.K.
        • Anderson G.L.
        Menopausal hormone therapy influence on breast cancer outcomes in the Women’s Health Initiative.
        J. Natl. Compr. Cancer Netw. 2015; 13: 917-924
        • Holmberg L.
        • et al.
        Increased risk of recurrence after hormone replacement therapy in breast cancer survivors.
        J. Natl. Cancer Inst. 2008; 100: 475-482
        • Gordhandas S.
        • et al.
        Hormone replacement therapy after risk reducing salpingo-oophorectomy in patients with BRCA1 or BRCA2 mutations; a systematic review of risks and benefits.
        Gynecol. Oncol. 2019 Apr; 153 (Epub 2019 Jan 17): 192-200https://doi.org/10.1016/j.ygyno.2018.12.014
        • Anderson G.L.
        • et al.
        Effects of conjugated equine estrogen in postmenopausal women with hysterectomy: the Women’s Health Initiative randomized controlled trial.
        JAMA. 2004; 291: 1701-1712
        • Lavasani S.
        • et al.
        Estrogen and colorectal cancer incidence and mortality.
        Cancer. 2015; 121: 3261-3271
        • Symer M.M.
        • et al.
        Hormone replacement therapy and colorectal cancer incidence and mortality in the prostate, lung, colorectal, and ovarian cancer screening trial.
        Clin. Colorectal Cancer. 2018; 17: e281-e288
        • Dashti S.G.
        • et al.
        Female hormonal factors and the risk of endometrial cancer in Lynch syndrome.
        JAMA. 2015; 314: 61-71