Can a 47-year-old safely use HRT after endometrial cancer?

Question

Hello doctor,

I am 47 years old, and I had surgery for endometrial cancer stage 1A grade 1 about eight months ago. The surgery included total hysterectomy and bilateral salpingo-oophorectomy, so now I am in full surgical menopause.

The symptoms are honestly unbearable: hot flashes every hour, I cannot sleep at all, and my joint pain has gotten so bad that my orthopedic doctor is now asking if I have early-onset osteoporosis and has ordered a DEXA scan.

My gynecologist is hesitant to prescribe HRT, saying the estrogen could bring back the endometrial cancer, but I read somewhere that for early-stage cases, it might be considered.

My oncologist has not given me a clear answer either. I am also on Escitalopram, which my psychiatrist started for the mood symptoms, but it is not helping the physical menopause symptoms at all. My estradiol level came back extremely low at 8 pg/mL last week.

Can HRT be safely used after stage 1A endometrial cancer surgery, or is the risk of cancer recurrence too high, no matter what?

I just need to understand what options I have before my DEXA results come back and things get more complicated.

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

Your situation is one that we encounter quite frequently. Many patients undergo a total abdominal hysterectomy for endometrial cancer and subsequently experience menopausal and hormonal symptoms. One option that may be considered is the use of phytoestrogens, which are plant-derived compounds with estrogen-like effects.

These are available in certain herbal supplements and are generally not the same as conventional hormone replacement therapy (HRT). Because they are plant-based, their hormonal effects are typically much milder.

In addition, you may increase your intake of foods that naturally contain phytoestrogens, such as soybeans, soy products, anise, and fenugreek. These foods can sometimes help alleviate menopausal symptoms, although meaningful benefits may require regular and consistent consumption.

If symptoms do not improve sufficiently with phytoestrogens, then hormone therapy may be considered in selected cases. During any hormone treatment, close follow-up is important and may include regular clinical assessments and appropriate investigations to monitor your health and detect any potential problems at an early stage.

I hope you are satisfied with my answer. For further queries, you can consult me at iCliniq.

Thank you.