Hormone Replacement Therapy and Ovarian Cancer: Is There a Greater Risk?
- Ovarian cancer is cancer of the ovaries or the tissues surrounding the ovary.
- Hormone replacement therapy (HRT) is a type of menopausal therapy that is used to treat symptoms of menopause such as hot flashes, bone thinning, and vaginal dryness.
- Some studies have found that HRT use has been associated with higher levels of ovarian cancer incidence, whereas other studies have not found a significant relationship. "Careful discussion with your physician is the best way to get good information in a landscape that is always changing,” Dr. Bobbie Rimel from Cedars Sinai Medical Center says.
Hormone replacement therapy (HRT), a treatment prescribed to alleviate symptoms of menopause, is associated with an increased risk of ovarian cancer. However, the research regarding HRT and ovarian cancer is still in its infancy, and there are many nuances regarding its effects on one's health.
What is Ovarian Cancer?
Read MoreSymptoms of ovarian cancer can be subtle, which is one reason why so many cancers are diagnosed at an advanced stage.
What is Hormone Replacement Therapy?
Hormone replacement therapy (HRT) is used to treat some of the side effects of menopause in women. Some women experience intense symptoms during menopause, such as hot flashes, problems with sleeping, bone thinning, and pain during sex. As a result, doctors may prescribe hormone replacement therapy which controls the levels of estrogen and progesterone in one's body.
Is There a Greater Risk of Ovarian Cancer Incidence following Hormone Replacement Therapy?
Many studies have not found a correlation between HRT use and ovarian cancer incidence; however, the studies outlined below have found some positive associations.
A 2015 meta-analysis of 52 studies on HRT and ovarian cancer found that women who took progesterone and estrogen after menopause had an increased risk of being diagnosed with ovarian cancer. The risk was greatest for women actively taking HRT and decreased in the months after stopping therapy. This increase in risk was still present for women who underwent HRT for less than 5 years.
A 2019 meta-analysis of 26 studies including over 4 million women also found a correlation between HRT and ovarian cancer incidence for women in America and Europe. The correlation was highest in two subtypes (epithelial-stromal and endometrioid ovarian tumors). However, the association could not be reproduced in women in other continents, including Australia.
Lastly, in 2017 a study found that women on HRT had a 32% increased chance of developing serous borderline ovarian tumors.
It is important to note that HRT is sometimes part of ovarian cancer treatment after a woman has had her ovaries removed. Dr. Bobbie Rimel from Cedars Sinai Medical Center says, "There is actually some data that suggests improved survival with HRT given to ovarian cancer patients after diagnosis." In 2012, the results of a randomized control trial showed significantly improved survival in women with epithelial ovarian cancer who received HRT (estrogen) in addition to standard cancer treatment. However the routine use of HRT is also debated, as it minimizes the risk of osteoporosis, cardiovascular problems, and sexual dysfunction, but the evidence is considered "too limited" to support it being used routinely.
Dr. Stephanie Wethington from Johns Hopkins Medicine summarizes the confusion: "The data on HRT and risk of ovarian cancer are conflicting, with some studies showing no increase in the risk of ovarian cancer when taking HRT and others an increased risk. Even in studies which show an increase they do not show a marked increase, it is minimal."
Should I Still Use Hormone Replacement Therapy if it is Recommended for Me?
There are many other non-hormonal options to address menopausal symptoms. The best option should be individualized to each patient in consultation with your doctor.
Acupuncture, a therapy that involves the insertion of thin needles into specific points in the body, is a nonpharmaceutical treatment option that has been shown to decrease menopausal hot flashes and night sweats. This minimally invasive treatment option was also shown to improve other quality of life measures such as lessening sleep disturbances, depression, and anxiety.
Other therapies instead of HRT used to treat menopausal symptoms include non-hormonal treatment, such as Clonidine, to reduce menopausal hot flashes or the maintenance of a healthy diet and regular exercise.
“The best option for an individual patient will depend on which symptoms they are experiencing. For instance, hot flashes can be treated with SSRI or SNRI antidepressants, oxybutynin, or gabapentin. Vaginal dryness can be lessened with vaginal moisturizers or ospemifene. While vaginal estrogen is clearly a hormonal therapy the systemic absorption is low and so in some circumstances can be considered reasonable when systemic HRT is contraindicated,” Dr. Wethington recommends.
Dr. Rimel emphasizes: "Patients should receive counseling about the risks and potential benefits and make decisions with their doctors to use the lowest dose that works for them if non-hormonal methods are not working."
How can I protect myself from ovarian cancer overall?
Dr. Rimel recommends, "Oral contraceptive use has consistently shown to lower ovarian cancer risk up to 50% if they are used for at least five years. Removal of the fallopian tubes for those who do not desire future pregnancy can also reduce risk by approximately 50%."
Dr. Wethington adds, “Know your family history! The most important thing is to know your family history of cancer and discuss it with your doctor. The discussion will include not only gynecologic cancer and breast cancer, but also colon and pancreatic, for instance. For women at elevated risk due to genetics, there are a variety of recommendations to mitigate risk specific to the particular genetic syndrome.”
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