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Original research
Vaginal estrogen use for genitourinary symptoms in women with a history of uterine, cervical, or ovarian carcinoma
  1. Laura M Chambers1,
  2. Alyssa Herrmann2,
  3. Chad M Michener1,
  4. Cecile A Ferrando3 and
  5. Stephanie Ricci4
  1. 1 Division of Gynecologic Oncology, Cleveland Clinic Foundation, Cleveland, Ohio, USA
  2. 2 Women's Health Institute and Department of Obstetrics and Gynecology, Cleveland Clinic, Cleveland, Ohio, USA
  3. 3 Department of Urogynecology, Cleveland Clinic, Cleveland, Ohio, USA
  4. 4 Gynecologic Oncology Division, Ob/Gyn and Women’s Health Institute, Cleveland Clinic, Cleveland, Ohio, USA
  1. Correspondence to Dr Laura M Chambers, Division of Gynecologic Oncology, Cleveland Clinic Foundation, Cleveland, OH 44195-5243, USA; chambel2{at}ccf.org

Abstract

Objective Menopausal symptoms may adversely affect quality of life and health in women diagnosed with a gynecologic malignancy. The aim of this study was to determine the incidence of adverse outcomes, including cancer recurrence, venous thromboembolism, and secondary malignancies, among patients with a history of endometrial, ovarian, or cervical cancer prescribed vaginal estrogen for genitourinary syndrome of menopause.

Methods A retrospective cohort study was performed including women who were diagnosed with endometrial, ovarian, or cervical cancer from January 1, 1991 to December 31, 2017 and subsequently treated with vaginal estrogen for genitourinary syndrome of menopause. Patients were included if not undergoing active cancer treatment and were disease-free based on most recent cancer surveillance visit with physical exam and/or imaging. Demographics, oncologic variables, estrogen use, and adverse outcomes were recorded. Descriptive statistics and univariate analysis were performed.

Results Of 244 women who received vaginal estrogen, 52% (n=127) had a history of endometrial, 25.4% (n=62) cervical, 18.9% (n=46) ovarian cancer, and 3.7% (n=9) low malignant potential tumors. The mean age and body mass index were 55.5±12.5 years and 29.2±8.6 mg/kg2, respectively. With a median follow-up of 80.2 months, the incidence of recurrence for endometrial, ovarian, and cervical cancer was 7.1% (n=9), 18.2% (n=10), and 9.7% (n=6), respectively. In patients with endometrial cancer who recurred, the incidence was 2.4% (n=3) for stage I/II and 4.7% (n=6) for stage III/IV disease. Similarly, recurrence rates for ovarian cancer were 4.3% (n=2) for stage I/II and 17.4% (n=8) for stage III/IV disease. All cervical cancer recurrences were in patients with stage I/II disease. Adverse outcomes including breast cancer (1.6%, n=4), secondary malignancy (2.5%, n=6), and venous thromboembolism (2.5%, n=6) were rare.

Conclusion In women with a history of endometrial, ovarian, or cervical cancer prescribed vaginal estrogen use for genitourinary syndrome of menopause, adverse outcomes, including recurrence and thromboembolic events, are infrequent. Vaginal estrogen may be considered safe in gynecologic cancer survivors.

  • cervical cancer
  • genitalia
  • female
  • ovarian cancer
  • quality of life (PRO)/palliative care
  • uterine cancer

https://doi.org/10.1136/ijgc-2019-001034

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    Footnotes

    • Twitter @laurajmoulton

    • Contributors All the authors contributed to this work. LMC: conception and design, collection and assembly of data, data analysis and interpretation, manuscript writing, final approval. AH: collection and assembly of data, data analysis and interpretation, manuscript writing, final approval. CF: data analysis and interpretation, manuscript writing, final approval. CM: conception and design, collection and assembly of data, data analysis and interpretation, manuscript writing, final approval. SR: conception and design, collection and assembly of data, data analysis and interpretation, manuscript writing, final approval.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available upon reasonable request.