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Management of menopausal symptoms and ovarian function preservation in women with gynecological cancer
  1. Annabelle Brennan1,
  2. Donal Brennan2,
  3. Margaret Rees3 and
  4. Martha Hickey4
  1. 1 Royal Women's Hospital, Parkville, Victoria, Australia
  2. 2 Gynaecology Oncology, Mater Misericordiae University Hospital, Dublin, Ireland
  3. 3 John Radcliffe Hospital, Oxford, UK
  4. 4 Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Victoria, Australia
  1. Correspondence to Dr Annabelle Brennan, Royal Women's Hospital, Parkville, VIC 3052, Australia; belle.brennan{at}


Gynecological cancers affect a growing number of women globally, with approximately 1.3 million women diagnosed in 2018. Menopausal symptoms are a significant health concern after treatment for gynecological cancers and may result from oncologic treatments such as premenopausal bilateral oophorectomy, ovarian failure associated with chemotherapy or radiotherapy, and anti-estrogenic effects of maintenance endocrine therapy. Additionally, with the growing availability of testing for pathogenic gene variants such as BRCA1/2 and Lynch syndrome, there is an increasing number of women undergoing risk-reducing oophorectomy, which in most cases will be before age 45 years and will induce surgical menopause. Not all menopausal symptoms require treatment, but patients with cancer may experience more severe symptoms compared with women undergoing natural menopause. Moreover, there is increasing evidence of the long-term implications of early menopause, including bone loss, cognitive decline and increased cardiovascular risk. Systemic hormone therapy is well established as the most effective treatment for vasomotor symptoms and vaginal (topical) estrogen therapy is effective for genitourinary symptoms. However, the role of hormone receptors in many gynecological cancers and their treatment pose a challenge to the management of menopausal symptoms after cancer. Consequently, the use of menopausal hormone therapy in this setting can be difficult for clinicians to navigate and this article aims to provide current, comprehensive guidance for the use of menopausal hormone replacement therapy in women who have had, or are at risk of developing, gynecological cancer to assist with these treatment decisions.

  • cervical cancer
  • ovarian cancer
  • uterine cancer
  • endometrial neoplasms
  • lynch syndrome II

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  • Contributors AB: preparation of first draft. DB, MR, MH: reviewed and edited draft. All authors approved final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests DB reports personal fees from GSK and research funding from Astra Zeneca, outside the remit of the submitted work. Management of Menopausal Symptoms and Ovarian Function Preservation in Women with Gynecologic Cancer.

  • Patient consent for publication Not required.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.