In a groundbreaking survey released on September 10, 2025, new insights have emerged regarding the prescribing habits of hormone therapy among gynecologists and gynecologic oncologists treating patients with histories of gynecologic cancers. Despite accumulating evidence supporting the safety of estrogen-based hormone therapy for patients with certain low-grade endometrial and epithelial ovarian cancers, a persistent reluctance remains among many clinicians to recommend these treatments. This hesitancy underscores a critical gap in the dissemination of evolving clinical guidelines and calls attention to the urgent need for enhanced education and awareness within the medical community.
Hormone therapy has been extensively documented as an effective approach for managing menopausal symptoms, including vasomotor instability and genitourinary syndrome, which profoundly impact quality of life. However, the context of gynecologic cancers has historically complicated the therapeutic decision-making process. Surgical treatments for such cancers commonly involve bilateral oophorectomy, thus inducing premature menopause in women who might be premenopausal or perimenopausal at diagnosis. Adding to the complexity, adjuvant chemotherapy and radiotherapy further compromise ovarian function, exacerbating menopausal symptoms and increasing the potential for long-term health detriments associated with hypoestrogenism.
This survey targeted a cohort of 293 respondents drawn from members of the Society of Gynecologic Oncology (SGO) and the American College of Obstetricians and Gynecologists, two leading organizations in women’s health. Their responses reveal a nuanced landscape of clinical practice, wherein approximately 64% are willing to prescribe estrogen therapy to patients with endometrial cancer, 65% feel comfortable offering it to those with epithelial ovarian cancer, and nearly 97% endorse its use in cervical cancer survivors. These figures illustrate both progress and a continuing divide in clinical perspectives, as nearly one-third of providers remain cautious or opposed to hormone administration despite evidence supporting its safety in select patient populations.
The persistence of conservative prescribing patterns is influenced by several factors, including clinician demographics, professional roles, and experience levels. Female providers and those specializing in benign gynecology or holding fewer years of clinical practice show a greater tendency toward misperceptions regarding the oncologic risks associated with hormone therapy. The survey highlights that misconceptions, rather than empirical data, significantly influence therapeutic choices, potentially depriving patients of symptom relief and protective health benefits linked to hormone replacement.
Clinically, the risk-benefit calculus for hormone therapy post-gynecologic cancer requires refinement beyond broad generalizations. Whereas earlier dogma prescribed universal avoidance of estrogen due to fears of cancer recurrence or progression, current research and consensus guidelines illustrate that for many low-risk cancers, hormone therapy does not increase recurrence risk and may in fact improve overall survivorship quality. The Society of Gynecologic Oncology, in collaboration with The Menopause Society, issued statements as early as 2020 recommending individualized consideration of hormone use in this population, signaling a paradigm shift toward more nuanced and patient-centered care.
Alternative treatments for managing menopausal symptoms were also examined in the survey. Selective serotonin reuptake inhibitors (SSRIs) were the most frequently preferred substitutes for estrogen therapy, selected by 88.4% of respondents. Gabapentin and neurokinin-3 receptor antagonists were chosen by 58% and 46.4%, respectively. While these agents may mitigate symptoms such as hot flashes, their efficacy does not match that of direct hormone replacement, and their use carries its own spectrum of side effects and limitations. This preference for non-hormonal agents reflects a combination of clinical caution and knowledge gaps rather than optimized patient care.
The biological underpinnings of hormone therapy’s safety in gynecologic oncology patients rest on tumor receptor status, histologic grade, and cancer staging. Low-grade endometrial and epithelial ovarian cancers often exhibit limited or absent estrogen receptor activity, diminishing the theoretical basis for estrogen-induced tumor proliferation. Moreover, estrogen therapy has been shown in controlled studies not to exacerbate recurrence rates in these subsets, and indeed may confer benefits on cardiovascular, skeletal, and neurocognitive health, all of which are adversely affected by premature estrogen deprivation.
Beyond the clinical implications, this survey’s findings carry significant public health ramifications. With a substantial portion of gynecologic cancer survivors enduring early menopause and its sequelae, optimizing symptom management is imperative for enhancing long-term quality of life. Untreated menopausal symptoms can negatively affect sleep, mood, sexual function, and bone density, ultimately increasing morbidity and mortality risks. Ensuring that providers are well-informed and confident in prescribing hormone therapy where appropriate aligns closely with contemporary goals of survivorship care and holistic patient wellness.
Dr. Monica Christmas, associate medical director for The Menopause Society, emphasized the critical importance of recognizing when hormone therapy can be safely employed. She noted that hormone therapy remains the most effective modality for alleviating vasomotor symptoms and genitourinary syndrome in women with gynecologic cancer histories. The challenge remains to dismantle outdated perceptions and integrate updated evidence into routine clinical practice swiftly and comprehensively.
To expedite this shift, targeted educational initiatives are recommended, including continuing medical education modules, interdisciplinary symposiums, and updated clinical guidelines emphasizing individualized risk assessment. Bridging the knowledge gap will facilitate equitable access to hormone therapy, enabling more patients to benefit from its therapeutic potential without undue fear of adverse oncologic outcomes. Furthermore, fostering open patient-provider communication about hormone therapy risks and benefits will empower women in shared decision-making regarding their menopausal symptom management.
In conclusion, this landmark survey highlights a critical juncture in gynecologic oncology care, where the intersection of oncologic safety and quality-of-life considerations demands refined clarity and action. As evidence mounts supporting the appropriate use of hormone therapy in select cancer survivors, overcoming persistent provider hesitancy is paramount. The broad implementation of evidence-based educational efforts promises to reshape clinical attitudes, improve patient outcomes, and redefine standards of care for women navigating the complex landscape of gynecologic cancer survivorship and menopause.
Subject of Research: Animals (Note: This appears inconsistent with the content focused on human clinical survey data; possibly a metadata error.)
Article Title: Estrogen therapy in patients with gynecologic cancer: a survey of gynecologists and oncologists in the United States
News Publication Date: September 10, 2025
Web References:
https://menopause.org/wp-content/uploads/press-release/MENO-D-25-00238.pdf
http://dx.doi.org/10.1097/GME.0000000000000002643
References: None reported.
Image Credits: Not provided.
Keywords: Health and medicine
