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abstract
Purpose of review: 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.
Recent findings: 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.
Summary: 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.
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