Gynaecological oncology perspective on management of the menopause

Treatment for gynaecological cancer may ablate ovarian function through surgery (oophorectomy), radiotherapy or chemotherapy. Bilateral oophorectomy or surgical menopause results in an immediate menopause which may be intensely symptomatic in young women. Also oestrogen deficiency before the age of 40 increases the risk of osteoporosis and cardiovascular disease. This article will describe the use of oestrogen and non-oestrogen-based treatments as well as alternative and complementary therapies in gynaecological cancer survivors.

To review the use of oestrogen and non-oestrogen-based treatments as well as alternative and complementary therapies in gynaecological cancer survivors in whom ovarian function has been ablated through surgery (oophorectomy), radiotherapy or chemotherapy.

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Ovarian, cervical, vaginal and vulval cancers are not oestrogen dependent conditions and oestrogen replacement is not contraindicated. However, there is some doubt with regard to endometrioid ovarian cancer and endometrial carcinoma is often listed in data sheets as an absolute contra-indication to hormone replacement therapy. Progestogens may be effective in treating vasomotor symptoms. A variety of agents are available for the prevention and treatment of osteoporosis and all except parathyroid hormone and strontium ranelate act mainly by inhibiting bone resorption. There is little scientific evidence that complementary and alternative therapies can help menopausal symptoms or conserve bone mass and there are no safety data in women with gynaecological cancer.

Oestrogen-based therapies are the treatments of choice in young women with a premature menopause since oestrogen deficiency before the age of 40 increases the risk of osteoporosis and cardiovascular disease.