- The condition can cause vasomotor problems, like hot flashes, trouble sleeping, sudden increases in temperature and genital atrophy, which causes constant itching
- Patients with cervical or endometrial cancer may benefit from estrogen-induced menopause
- Some gynecological and hormone-dependent cancers react to this therapy with very positive results, with no evidence of increased risk of breast cancer in patients on Hormone Replacement Therapy (HRT)
Madrid, August 3, 2021 - Menopause is the cessation of ovarian activity in women, marking the end of their reproductive period and it occurs clinically after a full year without periods. In Spanish women, this normally occurs between the ages of 50 and 51, and functionally occurs because women are born with a follicular reserve that is determined in fetal life, and that reserve is depleted as a woman’s fertile age advances. This is what is known as physiological menopause, although there are also periods when the ovaries stop working, when periods stop for secondary reasons, and that can occur, for instance, after cancer treatment.
HRT is recommended for all menopausal women with symptoms that affect their quality of life. "If the symptoms do not let you sleep, if you cannot lead a normal life, we recommend the use of HRT, where we prescribe personalized treatment to control the risks, although the benefits far outweigh the risks", states Dr. Carmen Yelo, of the Gynecologic Oncology Service at MD Anderson Cancer Center Madrid.
This therapy, as its name indicates, is used to replace a physiological situation and consists of “administering the hormones that your body has stopped producing, with estrogens and gestagens or other drugs, but artificially, which causes a similar effect to restore balance. The symptoms and consequences of menopause can be treated and can be prevented to stop them from progressing”.
Vasomotor problems and genital atrophy: the 'workhorses' of menopause
According to Dr. Yelo, there are two "workhorses" of menopause: vasomotor problems and genital atrophy, both are the result of estrogen deficiency. Vasomotor problems can trigger hot flashes, cause trouble sleeping or sudden increases in temperature, while genital atrophy results in a thinning of the vaginal mucosa because of estrogen deficiency. The vaginal mucosa becomes thinner and leadings to constant itching. "Often patients might even mistake it for urinary symptoms, with a frequent urge to go to the bathroom, but it is not really related to an infection as such," warns the doctor.
With regard to genital atrophy, the specialist insists that the vaginal health of women going through menopause should also be taken into account. They are young women, around 50 years old, who have an active sexual life many years ahead of them and if the atrophy progresses, it will cause a lot of problems in their personal relationships. In these cases, hormone treatment is recommended for all women going through the menopause, whether or not they have symptoms, because, in the long run, they will have to face these problems.
Hormone Replacement Therapy for cancer patients
Cervical cancer is most often related to the human papillomavirus (HPV) and is usually operated on in very young women. In 97% of cases there is no link to hormones and HRT is indicated. "These cervical cancer patients benefit from having periods and this treatment is specifically recommended if they need hormone therapy because they have had premature natural menopause or have a lot of symptoms," explains the doctor.
In the case of patients with endometrial cancer, they must be approached individually. These are patients without a uterus, having undergone surgery as part of their treatment, and they can benefit from estrogen treatments like hormone replacement therapy.
In patients with breast cancer, the doctor advises opting for other types of treatment. “A patient with a history of breast cancer cannot benefit from hormone replacement therapy. For these patients there are other more effective alternatives that do not involve hormones, like antidepressants or neurotransmitter uptake inhibitors, which help relieve hot flashes. For genital atrophy, in particular, there are topical drugs that do not alter the levels of estrogen in the blood and are safe in patients with a history of breast cancer”.
Increased risk of cancer in patients with HRT
Although it is true that about 20 years ago, studies were published that pointed to an increased risk of breast cancer in patients with hormone replacement therapy, a posteriori scientific evidence has shown that following the regimens and guidelines currently administered, the risk does not exist in well-monitored patients.
Later studies also point out that the risk of breast cancer does not exist in patients with a personal history of cancer. Nowadays, some gynecological and hormone-dependent cancers benefit from the use of HRT, because the benefits of returning patients to a situation as near as possible to their natural physiological state is greater than the risks that might be associated with the use of hormone replacement therapy.
"It is a totally indicated treatment," says Dr. Carmen Yelo, "because what they gain in quality of life is much greater than the risk," he goes on to state, as long as the therapy is administered immediately after amenorrhea (when periods stop), for a period maximum five years and, at most, up to 60 years.
About MD Anderson Cancer Center Madrid
MD Anderson Cancer Center Madrid is an affiliate of the prestigious MD Anderson Cancer Center in Houston, Texas, USA. With more than twenty years’ history in Spain, MD Anderson Cancer Center Madrid currently offers modern facilities with over 150 medical specialists trained in oncology, a total of 87 hospitalization beds and state-of-the-art technology for the diagnosis and treatment of the different types of cancer.
This large infrastructure, together with continuous, close collaboration with the MD Anderson Center in Houston on investigation, and diagnostic and treatment protocols with the participation of a multidisciplinary team of specialists, make MD Anderson Cancer Center Madrid one of the leading hospitals in Europe in cancer treatment. For further information: mdanderson.es