Journal: BJOG : an international journal of obstetrics and gynaecology
This publication is a narrative review on the use of hormone replacement therapy (HRT) in women with a history of cancer or at increased cancer risk.
Key points:
- HRT effectiveness: HRT remains the most effective treatment for vasomotor symptoms and genitourinary syndrome of menopause and has established benefits for bone health and prevention of osteoporosis.
- Impact of earlier studies: Earlier studies suggesting increased cancer risk with HRT substantially altered prescribing patterns, clinician attitudes, and public perception, leading to ongoing caution despite more recent, more nuanced safety data.
- Groups of particular concern: Concerns are particularly acute in:
- Cancer survivors: Especially those with hormone‑sensitive tumours.
- High‑risk women: Women with strong family histories or genetic predispositions to cancer.
- Prescribing reluctance: Many oncologists and other clinicians are reluctant to prescribe HRT because of the theoretical risk of stimulating cancer growth or recurrence, even when menopausal symptoms or treatment‑induced menopause significantly impair quality of life.
- Iatrogenic menopause: A large and growing population of women experience iatrogenic premature or early menopause due to cancer treatment, or develop significant menopause-like, hormone-related side effects during therapy.
- Quality of life and survivorship: With improving cancer survival, quality-of-life issues, including menopausal symptom control, have become increasingly important in long‑term care and survivorship planning.
- Evidence synthesis and goals: The article synthesizes existing evidence on cancer risk and HRT in these contexts to:
- Clarify appropriate use: Clarify where HRT may be reasonably considered.
- Cautionary areas: Highlight areas where caution or avoidance is warranted.
- Shared decision-making: Support individualized, shared decision-making that balances symptom burden, long‑term health risks, and cancer‑related considerations.
Overall message: The authors advocate for evidence-based, patient-centred discussions about HRT rather than blanket avoidance in all women with current or previous cancer or elevated cancer risk.