Managing menopausal symptoms in women who have a history of pelvic cancer: Is hormone replacement therapy appropriate?

Abstract

Managing menopausal symptoms involves many different options, including both hormonal and non-hormonal interventions. Hormone replacement therapy (HRT) is the most effective treatment option available for women experiencing classical menopausal symptoms, such as vasomotor symptoms and sleep disturbance. If HRT is to be considered, this should be based on an individualised risk assessment. Decisionmaking around HRT prescribing can be challenging in women who have a complex medical history, including women with a history of a hormone-dependent cancer. An ever-increasing number of cancer survivors now live long enough to reach the natural age of menopause or they may experience menopausal symptoms earlier as a side effect of treatment (surgery, chemotherapy or radiotherapy). When considering treatment options for menopausal symptoms, the oncologic risk of HRT – the potential to cause cancer recurrence and progression – is difficult to assess. Individualised decision-making is needed, but the evidence on which this should be based is not always clear. Collaboration with oncologists and surgeons is needed to ensure that long-term patient safety is not compromised for short-term symptom control. Guidance published recently in a joint statement from the Royal College of Obstetricians and Gynaecologists (RCOG), the British Menopause Society (BMS) and the Society for Endocrinology provides an evidence base to help clinicians advising women experiencing symptoms of menopause. It is important that women have the right information and are supported by appropriate clinicians when making decisions about their treatment and care. Alongside this, the National Institute for Health and Clinical Excellence (NICE) published helpful guidance that provides a framework for shared decision-making and advocates the use of clinical decision aids to support a collaborative approach between the clinician and the patient. In these tales, two cases are presented, relating to women with a history of pelvic cancer (endometrial and bladder cancer). Both women presented for advice in relation to managing menopausal symptoms. Case 1