January 8, 2002
Hormone replacement therapy and cancer: Balancing safety and quality
of life
Cancer treatment can cause early menopause
E. Ginsburg, MD
Treatments for any kind of cancer can propel young women into early menopause, making HRT an issue sooner than it normally would be. These treatments include oophorectomy (removal of the ovaries), chemotherapy, or pelvic radiation.
"Because menopause did not occur naturally and gradually, these women often have more severe symptoms," says Elizabeth Ginsburg, MD, a reproductive endocrinologist. "The hot flashes are more extreme, and there is more dramatic vaginal dryness and thinning of the vaginal walls." After they complete treatment, women in their 20s and 30s tend to regain their menstrual cycles eventually, while women in their 40s do not, says Dr. Ginsburg.
The decision about whether or not to take HRT often rests on the kind of cancer the woman had. A breast cancer survivor may decide not to take it.
"On the other hand, if the cancer was ovarian and the ovaries were removed, we generally do give HRT because these women tend to have severe symptoms," says Dr. Ginsburg. "I give estrogen in a dose that helps with the hot flashes, then taper off. I also give progestins that are safer than Provera, the type used in the WHI study, from a cardiovascular point of view. I try to gradually reduce the HRT around the time natural menopause would have occurred."
Next page: Women who have cancer
