Joint statement on menopausal symptoms, osteoporosis after gynecological cancer

March 17, 2020

Because all gynecological cancers are not the same, women surviving gynecological cancer should be able to access individualized therapies, according to the European Menopause and Andropause Society (EMAS) and the International Gynecologic Cancer Society (IGCS).

Because all gynecological cancers are not the same, women surviving gynecological cancer should be able to access therapies appropriate for their age, tumor type, stage of menopause symptoms and skeletal conservation.

That is the take-home message of a joint position statement on managing menopause following gynecological center, with a focus on menopausal symptoms and osteoporosis, by the European Menopause and Andropause Society (EMAS) and the International Gynecologic Cancer Society (IGCS) in both the journal Maturitas and the International Journal of Gynecological Cancer.

Worldwide, it is estimated there are roughly 1.3 million new gynecological cancer cases diagnosed annually, for which treatments include hysterectomy (with or without bilateral salpingo-oophorectomy), radiotherapy and chemotherapy./p>

“However, these therapies can result in loss of ovarian function and, in women under the age of 45, early menopause,” said senior author Margaret Rees, MD, DPhil, reader emeritus in reproductive medicine at the University of Oxford in the United Kingdom. “Management depends on tumor type and stage, along with the woman’s age.”

Individualized approach
The aim of the position statement is to embrace an individualized approach to the management (with or without menopausal hormone therapy) of both menopausal symptoms and the prevention and treatment of osteoporosis in women with gynecological cancer.  

Osteoporosis causes more than 8.9 million fractures annually worldwide, and hip fracture is associated with significant excess mortality.

This is the first time either EMAS or IGCS has generated a position statement on the topic.

“There is a need to ensure that women treated for gynecological cancer receive individualized therapy,” Prof. Rees told Contemporary OB/GYN

The limited data available indicates that women with low-grade, early-stage endometrial cancer may consider systemic or topical estrogens.

“However, because menopausal hormone therapy may stimulate tumor growth in patients with more advanced disease, non-hormonal approaches are recommended,” Prof. Rees said.

Likewise, uterine sarcomas may be hormone-dependent. “Therefore, estrogen and progesterone receptor testing should commence for decision-making about whether menopausal hormone therapy or non-hormonal strategies are appropriate,” Prof. Rees said.

But there are no longer-term data about the safety of menopausal hormone therapy in women with Lynch syndrome.

Similarly, in women whose sarcomas are steroid receptor negative or who have smooth muscle tumors of uncertain malignant potential, no clinical trial data are available to inform practice.

Ovarian cancer
For ovarian cancer, menopausal hormone therapy does not decrease overall or disease-free survival in women with non-serous epithelial ovarian cancer and germ cell tumors.

The regimen (estrogen or estrogen combined with progestogen), however, depends on whether hysterectomy has occurred, whereas duration of therapy depends on the woman’s age.

“Still caution is required for both systemic and topical menopausal hormone therapy in women with serous and granulosa cell tumors because of their hormone dependence,” Prof Rees said. “Consequently, non-hormonal options are recommended as initial therapy in these women.”

There is no evidence to contraindicate the use of systemic or topical menopausal hormone therapy for cervical, vaginal or vulvar cancer, according to the position paper. “These tumors are not considered to be hormone dependent,” Prof. Rees said. “Again, though, the regimen – unopposed or opposed estrogen – depends on whether hysterectomy has been undertaken.”

Prof. Rees is hopeful that the position statement will change clinical practice,” so that women receive information-based advice regarding their future management. There is also a need for randomized controlled trials and longitudinal studies to provide a stronger evidence base to inform practice.”

 

Disclosures:

Dr. Rees reports no relevant financial disclosures.