Courtesy of Roswell Park Cancer Talk Blog

To dispel myths and provide guidance, gynecologic oncologist Nicole Gaulin, MD, and Sheheryar Kabraji, BMBCh, Chief of Breast Medicine at Roswell Park Comprehensive Cancer Center, address some common concerns and questions.

What is hormone replacement therapy?

Dr. Gaulin explains that hormone replacement therapy, such as synthetic estrogen and/or progesterone, supplements the naturally produced estrogen and progesterone in women assigned female at birth to compensate for the lack of these hormones, which occurs with menopause. But insufficient natural ovarian production of estrogen and progesterone is just one reason for prescribing hormone replacement therapy, she says. It may also be given to women who undergo surgical menopause due to cancer treatment or those diagnosed with ovarian cancer. Some women whose ovaries have been damaged by chemotherapy or radiation might also be prescribed hormone replacement therapy. “Ovarian insufficiency is a debilitating condition that can increase the risk of cardiac death, all-cause mortality, fractures, and osteoporosis. Additionally, a lack of estrogen leads to genitourinary symptoms of menopause, such as vaginal dryness, dyspareunia, or pain with intercourse, urinary tract infections, and other conditions,” she says.

Why do some people believe replacement therapy is risky?

In the mid-1990s, the Women’s Health Initiative indicated some “potential adverse outcomes” linked to hormone replacement therapy, but women with primary ovarian insufficiency were not part of that study. The research did not consider the risks for younger women who start menopause in their 40s or earlier. “Now, we have excellent data to support the use of hormone replacement therapy in these women. The risk of vertebral fractures and hip fractures is significantly decreased with the use of hormone therapy. Also, women facing early menopause have a nearly 50% increased risk of ischemic-related cardiac morbidity, which can be significantly decreased with hormone therapy.”

What options are available for symptom management?

Oral contraceptives contain higher doses of estrogen and progesterone compared to available hormone replacement therapies, but they can still be an option if necessary. Other options include patches and oral medications.

As a breast oncologist, Dr. Kabraji sees a need to eliminate or reduce estrogen production to help patients fight cancer. However, he says, “Doing so results in side effects like hot flashes, joint pain, genitourinary, and other side effects. In my own practice, we talk to patients about using topical estrogens because the benefits can be significant, especially when it comes to those complications.”

What about women who have entered menopause naturally?

“The use of hormone replacement therapy in the menopausal setting is a bit more nuanced,” Dr. Gaulin explains. “Recommendations for this treatment are usually reserved for women under the age of 60 and are more favorable, with better outcomes, than for older women.”

This is why women should always discuss their options with their doctor—whether they are undergoing cancer treatment, facing primary ovarian failure, or are postmenopausal—before making any decisions about hormone replacement therapy.

October is Breast Cancer Awareness Month. For more resources and expert advice, visit roswellpark.org or call 1-800-ROSWELL (1-800-767-9355).