Saturday, October 6, 2012

Hormone replacement treatment and cancer

Some of my patients complained of severe hot flushes after their cancer surgery which includes surgery to remove their ovaries.   Hot flushes is a thermoregulatory dysfunction and could last for a few years after menopause (normal or surgical menopause).  The cause is unknown though we postulate due to hypothalamic estrogen withdrawal.  Vasomotor symptoms which may include sleep disturbance could be effectively treated with life style changes, estrogen vs non-estrogen (antidepressant, gabapentin, progestin).  Estrogen replacement is usually the most effective choice.   Antidepressant such as Paxil may be effective in reducing hot flushes symptoms.

In general, if you have cancer that responds to estrogen, then you should not be put on it.  Examples of such cancers are breast, uterine, possible ovarian cancer and others.   Squamous cell carcinoma of the cervix is usually safe to use estrogen.  Do remember that each drug may interact with your chemotherapy or other drugs that you take - it is wise to discuss it with your doctor and pharmacist.  Furthermore, some oncologists would put you on estrogen replacement therapy if you are a few years away after your diagnosis.  The theory here is recurrent cancer occurs usually in the first a few years after diagnosis.  the further away you are, the safer bet that your cancer recurrence risk has decreased.

Do discuss the risks and benefits with your oncologists before you start any medications or even supplements.

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