Management of induced menopause in gynaecological cancers and their challenges

Purpose of Review: The consequence of treatment for gynaecological cancers can cause sudden onset of intense menopausal symptoms, such as vasomotor symptoms, sexual dysfunction and emotional instability. Hormone replacement therapy (HRT) is often effective and can overcome these unpleasant and severe symptoms. However, data regarding its safety remains controversial. The big question therefore is whether HRT in gynaecological cancer survivors is possible. This is due to the fear of disease relapse. So, the purpose of this study was to review the evidence regarding cancer recurrence or death following use of HRT in survivors of gynaecological cancers. Recent Findings: For endometroid endometrial cancer, most of the retrospective studies concluded that there was no increase in recurrence rate of endometrial cancers in HRT versus non-HRT users. HRT should be particularly avoided in epithelial ovarian tumours particularly serous cancers and serous borderline tumours due to expression of oestrogen receptors. Given the lack of evidence on the impact of HRT on recurrence and disease-free survival in survivors of cervical cancers, it would seem perfectly reasonable to prescribe HRT, particularly if they are premenopausal. Many clinical guidelines would consider the use of HRT to be contraindicated in breast cancer survivors based on limited RCT evidence. Summary: Current scientific data, comprising mainly of retrospective studies, suggest that recurrence rates and survival are comparable between HRT users and non-users. Women should know the paucity of safety data regarding the use of HRT. Wherever possible, non-hormonal alternatives to HRT should be considered in all women. If non-hormonal alternatives fail to achieve adequate control of symptoms, then it is possible to consider the HRT after careful counselling of the patient as well as involvement of the oncology team in the decision-making process. However, more robust randomised controlled trials are needed to get convincing data regarding the safety of HRT in gynaecological cancer survivors

Menopausal hot flashing and endothelial function in two vascular beds: findings from a cross-sectional study of postmenopausal women

Objective: We sought to examine the association of menopausal hot flashing with vascular reactivity in two different vascular beds in the same cohort of postmenopausal women and explore the relationship between hot flashing and cardiovascular disease (CVD) risk profile. Methods: A cross-sectional study of 79 healthy postmenopausal women, 23 of whom have never had menopausal hot flashes and 56 of whom have reported hot flashes. Endothelial function at a microvascular level was measured with Laser Doppler Imaging with Iontophoresis which assesses the response to both acetylcholine (Ach, endothelium dependent) and sodium-nitroprusside (SNP, endothelium independent). Reactive Hyperemia Index (RHI) was measured with peripheral arterial tonometry as a marker of endothelial function mainly at a macrovascular level. Metabolic biomarkers including insulin sensitivity were assessed. Results: Women with hot flashes had enhanced microvascular response to Ach by ∼30% (P = 0.04) and to SNP by ∼31% (P = 0.02), but lower RHI by ∼13% (P = 0.05) compared with women without flashes. Hot flashing was associated with enhanced response to SNP and lower RHI after adjustment for confounders and conventional CVD risk factors. Women with hot flashes were more insulin resistant than nonflashers (HOMAIR: 1.9 (1.2-2.6) vs 1.4 (0.8-1.9), P = 0.03). Conclusions: Our data support the association of hot flashing with greater insulin resistance and lower macrovascular response. The paradoxical enhanced microvascular response in hot flashers could be the result of the net effect of thermoregulatory and nonnitric oxide-related pathways rather than of endothelial integrity

Menopause

Menopause is an inevitable component of ageing and encompasses the loss of ovarian reproductive function, either occurring spontaneously or secondary to other conditions. It is not yet possible to accurately predict the onset of menopause, especially early menopause, to give women improved control of their fertility. The decline in ovarian oestrogen production at menopause can cause physical symptoms that may be debilitating, including hot flushes and night sweats, urogenital atrophy, sexual dysfunction, mood changes, bone loss, and metabolic changes that predispose to cardiovascular disease and diabetes. The individual experience of the menopause transition varies widely. Important influential factors include the age at which menopause occurs, personal health and wellbeing, and each woman's environment and culture. Management options range from lifestyle assessment and intervention through to hormonal and non-hormonal pharmacotherapy, each of which has specific benefits and risks. Decisions about therapy for perimenopausal and postmenopausal women depend on symptomatology, health status, immediate and long-term health risks, personal life expectations, and the availability and cost of therapies. More effective and safe therapies for the management of menopausal symptoms need to be developed, particularly for women who have absolute contraindications to hormone therapy. For an illustrated summary of this Primer, visit: http://go.nature.com/BjvJVX

Менопауза

Menopause is an inevitable component of ageing and encompasses the loss of ovarian reproductive function, either occurring spontaneously or secondary to other conditions. It is not yet possible to accurately predict the onset of menopause, especially early menopause, to give women improved control of their fertility. The decline in ovarian oestrogen production at menopause can cause physical symptoms that may be debilitating, including hot flushes and night sweats, urogenital atrophy, sexual dysfunction, mood changes, bone loss, and metabolic changes that predispose to cardiovascular disease and diabetes. The individual experience of the menopause transition varies widely. Important influential factors include the age at which menopause occurs, personal health and wellbeing, and each woman’s environment and culture. Management options range from lifestyle assessment and intervention through to hormonal and non-hormonal pharmacotherapy, each of which has specific benefits and risks. Decisions about therapy for perimenopausal and postmenopausal women depend on symptomatology, health status, immediate and long-term health risks, personal life expectations, and the availability and cost of therapies. More effective and safe therapies for the management of menopausal symptoms need to be developed, particularly for women who have absolute contraindications to hormone therapyМенопауза является неизбежным компонентом старения и включает потерю репродуктивной функции яичников, возникает спонтанно или вторично в результате действия других факторов. Невозможно точно предсказать время наступления менопаузы, особенно ее начало, чтобы женщины имели возможность контролировать свою фертильность. Снижение выработки эстрогенов яичниками в период менопаузы может вызвать негативные физические симптомы – приливы и ночную потливость, урогенитальную атрофию, сексуальную дисфункцию, изменения настроения, потерю костной ткани и метаболические изменения, которые предрасполагают к возникновению сердечно-сосудистых заболеваний и диабета. Переходный менопаузальный этап индивидуален. Важными факторами, влияющими на менопаузу, являются возраст ее наступления, личное здоровье и благополучие, окружающая среда и культура женщины. Способы терапии симптомов менопаузы варьируют от оценки образа жизни до гормональной и негормональной фармакотерапии; каждый из них имеет определенные преимущества и риски. Решения о терапии в пери- и постменопаузе зависят от симптоматики, состояния здоровья и непосредственных и долгосрочных рисков для него, личных ожиданий женщины от жизни, а также доступности и стоимости лечения. Следует разработать более эффективные и безопасные методы контроля симптомов менопаузы, в частности, для женщин с абсолютными противопоказаниями к гормональной терапииМенопауза є неминучим компонентом старіння і включає втрату репродуктивної функції яєчників, виникає спонтанно або вторинно в результаті дії інших факторів. Неможливо точно передбачити час настання менопаузи, особливо її початок, аби жінки мали можливість контролювати свою фертильність. Зниження вироблення естрогену яєчниками в період менопаузи може викликати негативні фізичні симптоми – припливи і нічну пітливість, урогенітальну атрофію, сексуальну дисфункцію, зміни настрою, втрату кісткової тканини і метаболічні зміни, які призводять до виникнення серцево-судинних захворювань та діабету. Перехідний менопаузальний етап є індивідуальним. Важливими факторами, що впливають на менопаузу, є вік її настання, особисте здоров’я і благополуччя, навколишнє середовище і культура жінки. Способи терапії симптомів менопаузи варіюють від оцінки способу життя до гормональної та негормональної фармакотерапії; кожен із них має певні переваги і ризики. Рішення про терапію в пери- та постменопаузі залежить від симптоматики, стану здоров’я та безпосередніх і довгострокових ризиків для нього, особистих очікувань жінки від життя, а також доступності та вартості лікування. Слід розробити ефективніші та безпечніші методи контролю симптомів менопаузи, зокрема, для жінок з абсолютними протипоказаннями до гормональної терапі