Menopause in gynecologic cancer survivors: evidence for decision-making

Abstract

• Although advances in the treatment of gynecological cancer have improved survival rates, they may also increase the effects of induced menopause, especially in young women. • Cancer treatments such as oophorectomy, gonadotoxic chemotherapy, and pelvic radiotherapy can induce menopause. • Gonadotoxic chemotherapy, especially alkylating-containing regimens, often damages ovarian function and may result in permanent menopause. • Pelvic radiotherapy usually results in permanent loss of ovarian function unless ovarian transposition is performed. • Diagnosing menopause after cancer is challenging, and common diagnostic criteria such as 12 months or more of amenorrhea and elevated follicle-stimulating hormone (FSH) levels are not entirely reliable, since ovarian function may return years after treatment. • A multidisciplinary approach to post-cancer menopause is essential and should include an appropriate line of care, since hormone replacement therapy after treatment of gynecologic malignancy is controversial.

Figure 1. Definition of ovarian preservation according to gynecological cancer

Figure 2. Recommendations for hormone replacement therapy in ovarian cancer by histological type

Figure 3. Proposal for clinical decision-making on the indication of hormone therapy for women survivors of gynecological cancer

TTO - treatment Note: Hormone therapy may be prescribed for symptomatic women who do not improve with non-hormonal therapies, on an individualized basis, considering the woman’s symptoms and preferences.