Hormone replacement therapy after treatment for a gynaecological malignancy

Provision of hormone replacement therapy (HRT) to women following a diagnosis of a gynaecological malignancy is a complex and controversial area associated with a lack of published guidance. As the average age of women affected by gynaecological cancer decreases and survival following provision of effective therapies increases, clinicians face new considerations for longer-term health concerns of patients. Additionally, there is a growing understanding of the influence of tumour biology upon response to cytotoxic therapies and it is essential that we use this knowledge to guide provision of HRT.

Available evidence for ovarian, vulval, cervical, and endometrial cancers demonstrates no excess risk of recurrence in patients taking HRT with the exception of some subtypes of cancer (uterine sarcomas, granulosa cell, and low-grade serous ovarian cancer). Evidence for the incidence of hormone receptor status is suggestive that HRT may be ill-advised in an additional proportion of patients and we recommend characterization of all tumours in patients who may require HRT.

The risk and benefits of HRT should be evaluated for all women who undergo a premature menopause as a result of gynaecological malignancy to reduce menopausal symptoms and protect against cardiovascular and skeletal morbidity. There is no evidence to suggest a higher rate of disease recurrence in women using HRT in comparison to nonusers in the majority of gynaecological malignancies. Routine histological testing of tumours for hormone receptor status is an achievable goal and may help to stratify patients further into low and high-risk groups for hormone therapy.