Royal Women's Hospital, Parkville, Victoria, Australia
Gynaecology Oncology, Mater Misericordiae University Hospital, Dublin, Ireland.
Int J Gynecol Cancer. 2021 Mar;31(3):352-359. doi: 10.1136/ijgc-2020-002032. Epub 2020 Oct 30.
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.
妇科癌症在全球范围内影响着越来越多的女性，2018 年约有 130 万名女性被诊断出患有这种癌症。妇科癌症治疗后出现的更年期症状是一个重大的健康问题，可能是由于癌症治疗引起的，如绝经前双侧卵巢切除术、与化疗或放疗相关的卵巢衰竭，以及维持内分泌治疗的抗雌激素作用。此外，随着对 BRCA1/2 和林奇综合征等致病性基因突变检测的日益普及，越来越多的女性接受了降低风险的卵巢切除术，大多数情况下，这种手术在 45 岁之前进行，会导致手术性绝经。并非所有的更年期症状都需要治疗，但与自然绝经的女性相比，癌症患者可能会经历更严重的症状。此外，越来越多的证据表明，早期绝经会带来长期影响，包括骨质流失、认知能力下降和心血管风险增加。全身性激素治疗是治疗血管舒缩症状的最有效方法，阴道（局部）雌激素治疗对泌尿生殖系统症状有效。然而，许多妇科癌症中激素受体的作用及其治疗方法对癌症后更年期症状的管理构成了挑战。因此，临床医生在这种情况下使用更年期激素治疗可能会感到困难，本文旨在为有或有风险患上妇科癌症的女性提供更年期激素替代治疗的最新、全面的指导，以帮助做出这些治疗决策。
