MHT in cancer survivors

The decision of whether or not to use MHT after cancer is complex. It depends not only on indication (menopausal symptoms), but also on age and hormone dependence of the tumour. For example, squamous cell tumors of the cervix and vulva and hematological malignancies are not hormone dependent. However, breast tumours may express estrogen and progesterone receptors. Radiotherapy and chemotherapy can lead to premature ovarian failure, especially after cancer in childhood, leading to associated health consequences. Thus MHT is recommended in young women until the average age of the natural menopause after treatment for hematological malignancies as these tumours are not hormone dependent. There are also differences between systemic and topical (vaginal) estrogens. The latter have low systemic absorption. There are also differences between types of estrogen: estradiol vs estriol. Menopausal symptoms can be improved with non MHT options such as SSRIs or SNRIs and these are the treatments of choice after breast cancer in view of concerns of recurrence. Some tumours are not hormone dependent. A major problem is lack of randomised controlled trials to evaluate MHT regimens (estrogen alone, combined with a progestogen or bazedoxifene). In addition, some trials were terminated early, such as HABITS and Stockholm in breast cancer survivors. In conclusion cancer survivors should be managed by multidisciplinary teams involving menopause specialists, oncologists and gynaecologists to ensure that women benefit from up to date evidence-based practice