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Hormone sensitive cancers (DRAFT)

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Overview

If information relating to HRT use is not contained in prior oncology clinic letters, please refer the following women to the Menopause Oncology Clinic via eRS for discussion about management of menopause as HRT may not be appropriate / a risk factor for recurrence;

Breast Cancer

Uterine Cancer

Ovarian low grade / high grade serous

Ovarian granulosa cell

Ovarian endometriod

Meningioma / Prolactinoma

Liver adenoma / hepatocellular carcinoma

If you are unsure of the receptor status of a particular cancer and are unsure whether HRT is appropriate, please offer non-hormonal alternatives and ask for Advice and Guidance from the UHBW menopause clinic – two clinicians who work within the menopause oncology service provide Advice & Guidance through the e Referral Service (eRS) platform.

Alternatives to HRT

Women who are not eligible for HRT and are struggling with severe menopause symptoms despite trialling appropriate alternatives, can be referred to complex menopause service for advice and guidance or review.

Vaginal estrogen

This has a very low systemic absorption and can be considered in nearly all women, even for those in whom systemic HRT would be a relative contraindication. The exceptions would be women taking aromatase inhibitors for breast cancer, ovarian cancer or uterine sarcomas.

Referral

See Referrals to UHBW Menopause Clinic

Resources

Patient Resources

03-WHC-FACTSHEET-Complementary-And-Alternative-Therapies-NOV2023-C.pdf (womens-health-concern.org)

References and Resources

BGCS-BMS-Guidelines-on-Management-of-Menopausal-Symptoms-after-Gynaecological-Cancer.pdf

02-BMS-ConsensusStatement-BMS-WHC-2020-Recommendations-on-HRT-in-menopausal-women-SEPT2023-A.pdf (thebms.org.uk)

Managing menopause after cancer - The Lancet

Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

Information provided through Remedy is continually updated so please be aware any printed copies may quickly become out of date.