From the Guidelines
Hormone replacement therapy (HRT) is generally considered safe for women with a history of vulvar cancer, and can be used to alleviate menopausal symptoms that impact their quality of life, as stated in the most recent guideline 1. After completing treatment for vulvar cancer, patients can use HRT if they are experiencing significant menopausal symptoms. Standard HRT regimens include:
- Estrogen-only therapy (such as oral estradiol 0.5-1mg daily or estradiol patches 0.025-0.05mg/day) for women who have had a hysterectomy
- Combined estrogen-progestin therapy (like Prempro 0.3/1.5mg daily) for those with an intact uterus. Unlike some gynecologic cancers that are estrogen-dependent (such as endometrial cancer), vulvar cancer is not typically hormone-sensitive, and there is no strong evidence suggesting that HRT increases the risk of vulvar cancer recurrence, as supported by the gcig-consensus guideline for long-term survivorship in gynecologic cancer 1. However, individualized assessment is important, as factors like the specific type of vulvar cancer, stage, time since diagnosis, and other medical conditions should be considered. Women should discuss their specific situation with their oncologist and gynecologist to make an informed decision about using HRT after vulvar cancer treatment. It is also worth noting that the risk/benefit profile of hormone therapy is favorable for most gynecological cancer survivors, including those with vulvar cancer, as there is no evidence to contraindicate the use of systemic or topical hormone therapy for women with cervical, vaginal or vulvar cancers, as these tumors are not hormone-dependent 1. In addition, the prevention and management of osteoporosis should be the same as the general population, with supplementation of calcium and vitamin D, weight-bearing exercise, and treatment with bisphosphonates or denosumab if necessary 1. Overall, the use of HRT in women with a history of vulvar cancer should be individualized, taking into account the specific needs and medical conditions of each patient, and guided by the most recent and highest quality evidence available 1.
From the Research
Vulvar Cancer and Hormone Replacement Therapy
- The use of hormone replacement therapy (HRT) in patients with vulvar cancer is considered to be neutral, according to a study published in 2020 2.
- This study reviewed the latest evidence on HRT in survivors of gynecologic and non-gynecologic cancers, and grouped tumors according to the oncologic risk of properly chosen female hormone replacement therapy.
- Vulvar squamous cell carcinoma is listed as one of the tumors where HRT is considered neutral, meaning that it is not necessarily advantageous or disadvantageous.
- Another study published in 2023 discussed the real risks and benefits of HRT, and found that the benefits of HRT outweigh the risks in appropriate patients 3.
- However, this study did not specifically address the use of HRT in patients with vulvar cancer.
- A review of current recommendations for HRT use in menopausal women, published in 2022, discussed the benefits and potential risks of HRT, but did not provide specific guidance on its use in patients with vulvar cancer 4.
- Earlier studies, such as one published in 2017, discussed the role of HRT in reducing coronary heart disease and mortality, but did not address its use in patients with vulvar cancer specifically 5.
- A study published in 2007 discussed options for hormone therapy in women who have had a hysterectomy, and found that estrogen treatment is all that is needed when hot flashes and/or genital atrophic symptoms are associated with surgical or natural menopause, but this study did not address vulvar cancer specifically 6.