Elsevier

Maturitas

Volume 92, October 2016, Pages 86-96
Maturitas

Review article
Menopausal hormone therapy in cancer survivors: A narrative review of the literature

https://doi.org/10.1016/j.maturitas.2016.07.018Get rights and content

Highlights

  • Menopausal hormone therapy is not recommended for use in breast cancer survivors, and nonhormonal options for menopausal symptoms are advised.

  • Limited data suggest that MHT can be used in survivors of CRC, localized MM, and in hematologic cancers.

  • Data are insufficient to inform decision making regarding use of MHT in survivors of lung cancers, and caution is suggested.

  • Limited data suggest that MHT can be used in women with low grade, early stage type I endometrial cancer, epithelial ovarian cancer and germ cell tumors.

  • Squamous cell carcinomas of the cervix and vulva are not hormone-dependent, and MHT can be used.

Abstract

Decision making regarding the use of menopausal hormone therapy (MHT) for the treatment of bothersome menopausal symptoms in a cancer survivor can be complex, and includes assessment of its impact on disease-free or overall survival. Estrogen receptors are present in several cancer types, but this does not always result in estrogen-mediated tumor proliferation and adverse cancer-related outcomes. Estrogen may even be protective against certain cancers. Menopausal hormone therapy is associated with an increased risk of recurrence and mortality after diagnosis of some cancer types, but not others. We provide a narrative review of the medical literature regarding the risk of cancer recurrence and associated mortality with initiation of MHT after the diagnosis of breast, gynecologic, lung, colorectal, hematologic cancers, and melanoma. Menopausal hormone therapy may be considered for management of bothersome menopausal symptoms in women with some cancer types (e.g., colorectal and hematologic cancer, localized melanoma, and most cervical, vulvar and vaginal cancers), while nonhormonal treatment options may be preferred for others (e.g., breast cancer). In women with other cancer types, recommendations are less straightforward, and the use of MHT must be individualized.

Introduction

Cancer treatment may result in loss of ovarian function through surgical removal of the ovaries, chemotherapy, or radiation. While menopausal symptoms, such as hot flashes, night sweats, sleep disturbance, memory concerns, and mood issues can be extremely bothersome to some women going through menopause naturally, women who undergo an induced menopause usually experience more sudden and severe symptoms [1].

Menopausal hormone therapy (MHT) prescribing has declined dramatically since the Women’s Health Initiative (WHI) results in 2002 [2]. Also noteworthy is a downward shift in the proportion of women receiving hormone therapy prescriptions from their internist, family practitioner, or general practitioner relative to a gynecologist [2]. This shift occurs in the context of increasing numbers of women entering menopause, and increasing numbers of cancer survivors, with the majority of the latter group receiving survivorship care from their primary care providers. These women are also likely to seek treatment for relief from their bothersome menopausal symptoms from these same providers, who may be overwhelmed by the myriad of publications with ambiguous messages regarding the various risks and benefits of MHT [3]. While the decision to prescribe MHT can be complicated in women without cancer, the complexity increases further with a history of malignancy. In this study we provide a narrative review of the literature regarding MHT use after a diagnosis of breast, lung, colorectal, gynecologic, hematologic cancers, or melanoma, and practice considerations for female cancer survivors with bothersome vasomotor symptoms.

Section snippets

Methods

We searched PubMed, EMBASS, CINHALL, Medline, and PubMed Central for articles pertaining to MHT and lung, breast, colorectal, gynecologic, hematologic cancers, and melanoma. Key words included estrogen; progestin; hormonal influence; hormone therapy; menopause; MHT; and hot flashes. In order to make timely and relevant conclusions; only English-language articles published between January 2000 and January 2016 were included. Additional references were identified by cross-referencing the above

Breast cancer

Breast cancer is the most common invasive cancer in women, and in terms of cancer deaths, is second only to lung cancer.

Conclusions

Decision making regarding MHT following a cancer diagnosis is complex, and influenced not only by a woman’s age at menopause, the type of menopause (medically- or surgically-induced or natural), the severity of menopausal symptoms, medical and family history, and personal preferences, but also by the cancer type and stage. While MHT is not recommended following the diagnosis of some cancers (e.g., breast cancer), it can be used as indicated after other cancer diagnoses (e.g., hematologic

Practice points

  • MHT is not recommended for use in breast cancer survivors; non-hormonal options for menopausal symptoms are advised.

  • Limited data suggest that MHT can be used in survivors of CRC, localized MM, and in premature ovarian insufficiency resulting from treatment of hematologic cancers.

  • Data are insufficient to inform decision making regarding use of MHT in survivors of lung cancers, and caution is suggested.

  • Limited data suggest that MHT can be used in women with low grade, early stage type I

Research agenda

  • Additional RCT data are needed to further elucidate the association between MHT given after the diagnosis of several types of cancer (e.g., lung, colorectal, hematologic, MM) and risk of recurrence and mortality.

  • Future study is also needed to determine the significance of hormone receptor status in several tumor types (e.g., lung, endometrial, MM), and whether this might impact decision making regarding the use of MHT.

Contributors

CLK, EK, RS, JMT and SSF were involved in the conception and design of the research.

CLK, EK, RS, JMT and SSF reviewed the literature and contributed to the manuscript for specific cancer types.

AJ provided oversight and editing as a medical oncologist.

SSF and EK provided mentoring and undertook editing of the manuscript.

All authors were involved in critically revising the manuscript for its intellectual content and approving the final version.

Conflict of interest

All authors declare they have no conflicts of interest.

Funding

No government funding was used in the research or writing of this article.

Provenance and peer review

This article has undergone peer review.

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