Hormone Therapy After Endometrial Cancer

Some older women who develop endometrial cancer and have surgery to remove the uterus and ovaries as part of their treatment will have already gone through menopause.

Younger women with the cancer, including those who are still menstruating, will go through premature menopause if they have surgery that removes their uterus and ovaries. When this happens, they may develop typical symptoms of menopause as the body adjusts to a dwindling supply of estrogen. These symptoms include hot flashes, night sweats, mood swings, memory lapses, vaginal dryness, decreased libido, and/or insomnia. One way to ease these symptoms is with hormone replacement therapy (HRT).

This therapy should not be confused with the hormone therapy that is used to treat endometrial cancer and affects the gland cells in the tissues that line the uterus; the two therapies are entirely different.

HRT replaces the estrogen lost during menopause. It may consist of estrogen alone or estrogen given in combination with progesterone or progestin, a synthetic version of progesterone. 

The controversy over hormone therapy

HRT can offer relief for postmenopausal women plagued by change-of-life symptoms, but studies have shown that it can raise their risk of developing dementia, breast cancer, and other diseases.

For survivors of endometrial cancer, there are other concerns. Because endometrial cancer is thought to be an estrogen-linked cancer, the fear is that the estrogen used in HRT therapy may drive up the risk of an endometrial cancer recurrence. For this reason, estrogen replacement therapy isn't typically suggested for women who have been treated for endometrial cancer.

Only limited research has been done on this HRT risk. Guidelines on treating uterine cancers from the National Comprehensive Cancer Network (NCCN), an alliance of 21 leading cancer centers from around the world, note that studies have not conclusively proved that estrogen replacement therapy causes a higher relapse rate of endometrial cancer. The NCCN panel of reviewers believes that estrogen replacement therapy is a reasonable option for patients at low risk of a recurrence of endometrial cancer and offers these suggestions:

  • Any recommendation for HRT should be on an individual basis.

  • Your medical team should discuss it with you in detail. It is very important that your particular findings be put into context by an expert. Gynecologic oncologists are subspecialists with advanced training in the diagnosis, treatment, and surveillance of female cancers including endometrial cancer.

  • You should wait 6 to 12 months after treatment before going on HRT.

  • You may have other options to HRT that can relieve menopausal symptoms. Talk with your doctor about the possibility of prescribing a selective estrogen-receptor modulator, such as raloxifene, which does not appear to stimulate breast or uterine tissue in a way that might induce cancer. (Unfortunately, raloxifene does not dampen the menopausal changes that result in hot flashes.)

If you are reluctant to try HRT after your treatment for endometrial cancer, you can try to minimize hot flashes and other annoying symptoms of menopause with these lifestyle tips: 

  • Ease hot flashes by wearing layers of clothing that you can easily shed, taking care not to overheat yourself, and pinpointing and then avoiding your hot flash triggers.

  • Experiment with an over-the-counter lubricant to reduce vaginal dryness.

  • To combat insomnia, get daily exercise and set a regular bedtime and wake time.

  • Rely on exercise, a healthy amount of sleep, and stress management techniques to manage your mood swings.

  • Ask your doctor about mental exercises you can do to help your mind stay sharp if you're having memory lapses.

  • Look for a support group for women going through the same phase of life.