Hormone replacement therapy in surgical menopause after gynecological malignancies

Dragana  Tomić Naglić; Aljoša  Mandić; Milica  Zirojević; Nikolina Vuković; Sladjana  Pejaković; Mia Manojlovic; Ivana  Bajkin; Tijana Ičin; Stefan  Janičić; Edita  Stokić

doi:10.17305/bb.2024.11220

Authors

Dragana Tomić Naglić University of Novi Sad, Faculty of Medicine in Novi Sad, Novi Sad, Serbia; Clinic for Endocrinology, Diabetes and Metabolic Disorders, Clinical Center of Vojvodina, Novi Sad, Serbia
Aljoša Mandić University of Novi Sad, Faculty of Medicine in Novi Sad, Novi Sad, Serbia; Institute of Oncology of Vojvodina, Sremska Kamenica, Serbia
Milica Zirojević University of Novi Sad, Faculty of Medicine in Novi Sad, Novi Sad, Serbia; Clinic for Endocrinology, Diabetes and Metabolic Disorders, Clinical Center of Vojvodina, Novi Sad, Serbia
Nikolina Vuković University of Novi Sad, Faculty of Medicine in Novi Sad, Novi Sad, Serbia; Clinic for Endocrinology, Diabetes and Metabolic Disorders, Clinical Center of Vojvodina, Novi Sad, Serbia https://orcid.org/0009-0001-8892-4325
Sladjana Pejaković University of Novi Sad, Faculty of Medicine in Novi Sad, Novi Sad, Serbia; Clinic for Endocrinology, Diabetes and Metabolic Disorders, Clinical Center of Vojvodina, Novi Sad, Serbia https://orcid.org/0000-0002-9654-6395
Mia Manojlovic University of Novi Sad, Faculty of Medicine Novi Sad; Clinic for Endocrinology, Diabetes and Metabolic Disorders, Clinical Center of Vojvodina, Novi Sad, Serbia https://orcid.org/0000-0001-5176-5650
Ivana Bajkin University of Novi Sad, Faculty of Medicine in Novi Sad, Novi Sad, Serbia; Clinic for Endocrinology, Diabetes and Metabolic Disorders, Clinical Center of Vojvodina, Novi Sad, Serbia
Tijana Ičin University of Novi Sad, Faculty of Medicine in Novi Sad, Novi Sad, Serbia; Clinic for Endocrinology, Diabetes and Metabolic Disorders, Clinical Center of Vojvodina, Novi Sad, Serbia https://orcid.org/0000-0002-3886-6518
Stefan Janičić University of Novi Sad, Faculty of Medicine in Novi Sad, Novi Sad, Serbia; Clinic for Endocrinology, Diabetes and Metabolic Disorders, Clinical Center of Vojvodina, Novi Sad, Serbia https://orcid.org/0000-0003-1826-9721
Edita Stokić University of Novi Sad, Faculty of Medicine in Novi Sad, Novi Sad, Serbia; Clinic for Endocrinology, Diabetes and Metabolic Disorders, Clinical Center of Vojvodina, Novi Sad, Serbia

DOI:

https://doi.org/10.17305/bb.2024.11220

Keywords:

hormone replacement therapy, HRT, surgical menopause, gynecological malignancies, quality of life, cardiovascular risk, bone health

Abstract

This review examines hormone replacement therapy (HRT) in cases of surgical menopause following gynecological malignancies. It aims to capture current knowledge, summarize recent findings, and provide recommendations for clinical settings. Unlike natural menopause, surgical menopause occurs abruptly, without an adjustment period, and is associated with a notably higher risk of fractures, arthritis, cognitive decline, dementia, Parkinson’s disease, and various metabolic disorders affecting glucose and lipid levels—all of which contribute to an increased risk of major cardiovascular events. In 2017, The North American Menopause Society recommended that, barring contraindications, HRT should be initiated in women who enter surgical menopause before age 45. If these women do not experience vasomotor symptoms or other issues, HRT should be maintained consistently at least until age 52. This guideline reflects contemporary knowledge and is the result of a multidisciplinary consensus, based on a review of existing literature and several randomized clinical trials focusing on women who have survived gynecological cancers and whose quality of life is significantly impacted by surgical or early menopause. Estrogen supplementation is particularly beneficial, as it is linked to marked improvements in quality of life, including delayed onset of chronic cardiovascular issues, reduced fracture risk, enhanced cognitive function, reduced inflammation, and improved self-esteem, as well as better social and work performance. Clinical implementation of HRT, however, requires a highly individualized approach. This approach must consider the type and stage of malignancy, histopathological characteristics, risk factors for recurrence (such as diet, concurrent medications, medical history, and genetic predispositions), and a thorough assessment of the potential benefits and risks of HRT, as well as the patient’s personal wishes and expectations.