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European Menopause and Andropause Society (EMAS) and International Gynecologic Cancer Society (IGCS) position statement on managing the menopause after gynecological cancer: focus on menopausal symptoms and osteoporosis
  1. Margaret Rees1,
  2. Roberto Angioli2,
  3. Robert Coleman3,
  4. Rosalind M Glasspool4,
  5. Francesco Plotti2,
  6. Tommaso Simoncini5 and
  7. Corrado Terranova2
  1. 1John Radcliffe Hospital, Oxford, UK
  2. 2Campus Bio-Medico, University of Rome, Rome, Italy
  3. 3MD Anderson Cancer Center, Houston, Texas, USA
  4. 4The Beatson West of Scotland Cancer Centre, Glasgow, UK
  5. 5Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
  1. Correspondence to Dr Margaret Rees, John Radcliffe Hospital, Oxford OX3 9DU, UK; margaret.rees{at}st-hildas.ox.ac.uk

Abstract

Worldwide, it is estimated that about 1.3 million new gynecological cancer cases are diagnosed each year. For 2018, the predicted annual totals were cervix uteri 569 847, corpus uteri 382 069, ovary 295 414, vulva 44 235, and va​gina 17 600. Treatments include hysterectomy with or without bilateral salpingo-oophorectomy, radiotherapy, and chemotherapy. These can result in loss of ovarian function and, in women under the age of 45 years, early menopause. The aim of this position statement is to set out an individualized approach to the management, with or without menopausal hormone therapy, of menopausal symptoms and the prevention and treatment of osteoporosis in women with gynecological cancer. Our methods comprised a literature review and consensus of expert opinion. The limited data suggest that women with low-grade, early-stage endometrial cancer may consider systemic or topical estrogens. However, menopausal hormone therapy may stimulate tumor growth in patients with more advanced disease, and non-hormonal approaches are recommended. Uterine sarcomas may be hormone dependent, and therefore estrogen and progesterone receptor testing should be undertaken to guide decisions as to whether menopausal hormone therapy or non-hormonal strategies should be used. The limited evidence available suggests that menopausal hormone therapy, either systemic or topical, does not appear to be associated with harm and does not decrease overall or disease-free survival in women with non-serous epithelial ovarian cancer and germ cell tumors. Caution is required with both systemic and topical menopausal hormone therapy in women with serous and granulosa cell tumors because of their hormone dependence, and non-hormonal options are recommended as initial therapy. There is no evidence to contraindicate the use of systemic or topical menopausal hormone therapy by women with cervical, vaginal, or vulvar cancer, as these tumors are not considered to be hormone dependent.

  • gynecology
  • Cancer
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Footnotes

  • Twitter @emas_online, @rcoledude

  • Presented at This statement is being simultaneously published in Maturitas and the International Journal of Gynecological Cancer on behalf of the European Menopause and Andropause Society (EMAS) and International Gynecologic Cancer Society (IGCS).

  • Contributors MR prepared the initial draft, which was circulated to all other named authors for comments and approval before review and endorsement by the EMAS board and IGCS council members. Production was coordinated by MR.

  • Funding No funding was sought or secured for this position statement.

  • Competing interests MR reports personal fees from Sojournix, Inc., outside the remit of the submitted work. RC reports grants from NIH, grants from Gateway Foundation, grants from VFounation, during the conduct of the study; grants and personal fees from AstraZeneca, grants from Merck, personal fees from Tesaro, personal fees from Medivation, grants and personal fees from Clovis, personal fees from Gamamab, grants and personal fees from Genmab, grants and personal fees from Roche/Genentech, grants and personal fees from Janssen, personal fees from Agenus, personal fees from Regeneron, personal fees from OncoQuest, outside the remit of the submitted work. RMG reports grants from Boehringer Ingelhiem, grants from Lilly/Ignyta, personal fees, non-financial support and other from AstraZeneca, personal fees and other from Tesaro/GSK, personal fees and other from Clovis, personal fees from Sotio, personal fees from Immunogen, outside the remit of the submitted work. TS reports personal fees from Abbott, Actavis, Bayer, and Estetra, as well as research support from Gedeon Richter, outside the remit of the submitted work. RA,FP and CT report no conflict of interest.

  • Patient consent for publication Not required.

  • Provenance and peer review Commissioned; internally peer reviewed.

  • Author note This statement is being simultaneously published in Maturitas and the International Journal of Gynecological Cancer on behalf of the European Menopause and Andropause Society (EMAS) and International Gynecologic Cancer Society (IGCS).

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