Hormonal Management of Menopausal Symptoms in Women With a History of Gynecologic Malignancy

Benjamin S. Harris, MD, MPH; Katherine C. Bishop, MD; Jeffrey A. Kuller, MD; Anne C. Ford, MD; Lisa C. Muasher, MD, MPH; Sarah E. Cantrell, MLIS; Thomas M. Price, MD


Menopause. 2020;27(2):243-248. 

In This Article


Among women with history of gynecologic malignancy, menopausal symptoms can not only affect quality of life, but can lead to significant morbidity and mortality due to hypoestrogenism. The benefits of HT for many symptomatic women in the general population are clear, but the risks may outweigh the benefits in certain populations, such as breast and gynecologic cancer survivors. The risks of HT should be assessed on an individual basis and in collaboration with an oncologist, with consideration of age, type of hormones, dose, duration of use, regimen, route of administration, and cancer history. Management with systemic therapy is not recommended in breast cancer survivors, whereas low-dose vaginal estrogen can be considered after discussion with the patient's oncologist. ET and EPT appear safe in gynecologic cancers of lower risk or less aggressive subtypes, and those that are not estrogen receptor positive.