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. 2025 Jan 15;156(2):280-292.
doi: 10.1002/ijc.35154. Epub 2024 Sep 2.

Use of menopausal hormone therapy before and after diagnosis and ovarian cancer survival-A prospective cohort study in Australia

Renhua Na  1   2 , Susan J Jordan  1   2 , Anna DeFazio  3   4   5 , Merran Williams  6 , Karen Livingstone  7 , Andreas Obermair  8 , Michael Friedlander  9 , Peter Grant  10 , Penelope M Webb  1   2 ; OPAL Study Group
Affiliations

Use of menopausal hormone therapy before and after diagnosis and ovarian cancer survival-A prospective cohort study in Australia

Renhua Na et al. Int J Cancer. .

Abstract

Menopausal hormone therapy (MHT) use before ovarian cancer diagnosis has been associated with improved survival but whether the association varies by type and duration of use is inconclusive; data on MHT use after treatment, particularly the effect on health-related quality of life (HRQOL), are scarce. We investigated survival in women with ovarian cancer according to MHT use before and after diagnosis, and post-treatment MHT use and its association with HRQOL in a prospective nationwide cohort in Australia. We used Cox proportional hazards regression to estimate hazard ratios (HR) and 95% confidence intervals (CI) and propensity scores to reduce confounding by indication. Among 690 women who were peri-/postmenopausal at diagnosis, pre-diagnosis MHT use was associated with a significant 26% improvement in ovarian cancer-specific survival; with a slightly stronger association for high-grade serous carcinoma (HGSC, HR = 0.69, 95%CI 0.54-0.87). The associations did not differ by recency or duration of use. Among women with HGSC who were pre-/perimenopausal or aged ≤55 years at diagnosis (n = 259), MHT use after treatment was not associated with a difference in survival (HR = 1.04, 95%CI 0.48-2.22). Compared to non-users, women who started MHT after treatment reported poorer overall HRQOL before starting MHT and this difference was still seen 1-3 months after starting MHT. In conclusion, pre-diagnosis MHT use was associated with improved survival, particularly in HGSC. Among women ≤55 years, use of MHT following treatment was not associated with poorer survival for HGSC. Further large-scale studies are needed to understand menopause-specific HRQOL issues in ovarian cancer.

Keywords: menopausal hormone therapy; ovarian cancer; propensity score; quality of life; survival.

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Conflict of interest statement

PM Webb received funding from AstraZeneca for an unrelated study of ovarian cancer. PM Webb has received a speaker's fee from AstraZeneca (Nov 2021). A DeFazio received an honorarium from AstraZeneca, and research support from AstraZeneca and lllumina, unrelated to the work described in this manuscript. ML Friedlander declares consulting/advisory boards AstraZeneca, Novartis, GSK, MSD; honoraria: AstraZeneca, GSK, MSD, Limbic; research grants to institution: AstraZeneca, Novartis and Beigene. All other authors declare that they have no conflict of interest that are relevant to the content of this article.

Figures

FIGURE 1
FIGURE 1
Flow diagram of the study cohort for use of menopausal hormone therapy and ovarian cancer survival (A) pre‐diagnosis analysis; (B) post‐diagnosis analysis.
See this image and copyright information in PMC

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