Menopausal Hormone Therapy Linked to Improved Ovarian Cancer Survival

Menopause is a universal biological reality for women of a certain age (the average age is 51, but it varies) with the potential to cause significant disruptive symptoms, including hot flashes, insomnia, mood swings, urinary frequency, vaginal dryness and bone loss.

And for most of human history, women have largely just had to suck it up. It seemed little could be done to alleviate these quality-of-life-crushing symptoms caused by decreasing levels of the "women's hormone" estrogen.

Then came the 1960s. Many things changed for women in the '60s, not the least of which was the widespread use of hormone replacement therapy (HRT)—known more commonly these days as menopausal hormone therapy (MHT). At last, women could get some relief from their symptoms.

And now, research has indicated MHT may actually improve chances of ovarian cancer survival. While going through menopause doesn't increase your odds of getting diagnosed with the disease, the reality is you are more likely to get ovarian cancer as you age.

The roller coaster ride of MHT

Over the years, the popularity of MHT has risen and fallen as new studies have come out:

• A downward plunge: In the 1970s, a link was discovered between MHT and endometrial cancer.
• Climbing up: Researchers discovered reducing the dosage of estrogen and combining it with progesterone could reduce the risk of endometrial cancer.
• Climbing way up: In 1988, the FDA approved MHT for the prevention of osteoporosis.
• A huge drop: In the early 2000s, results of two Women's Health Initiative studies came out linking MHT to a heightened risk of heart disease and breast cancer. Panic in the wake of this new information and misinterpretation of the data precipitated a sharp decline in the use of MHT by as much as 80 percent, according to an article published by the Yale School of Medicine.
• Ascending again: The emerging consensus among experts today is that for many women, the benefits of MHT often far outweigh the risks, and now, research published in 2020 links MHT to better survival rates for women with ovarian cancer.

Groundbreaking results

The results of a recent study of more than 6,400 postmenopausal women with ovarian cancer, published in the September 2020 issue of Gynecologic Oncology, indicate that use of MHT for at least five years prior to diagnosis was associated with a 20 percent better rate of survival.

In addition, women who used MHT were found to have less residual disease after primary debulking surgery (surgery that removes as much of the tumor as possible). The researchers examined MHT use by type and included estrogen-only therapy (ET) and estrogen plus progestin therapy (EPT) in their analysis.

The study was conducted by the Ovarian Cancer Association Consortium (OCAC), an international, multidisciplinary forum of investigators of case-control studies of ovarian cancer, with funding from the Ovarian Cancer Research Alliance.

OCAC researchers have been investigating how receiving MHT prior to diagnosis might affect survival rates for women with ovarian cancer for some time now. Unfortunately, two issues have thus far prevented meaningful results from their MHT studies: Too-small sample sizes and insufficient details about subjects' hormone regimens.

In this latest study, OCAC analyzed data from its 15 previous studies on MHT and ovarian cancer. By combining and examining information from this much larger data set, they were able to glean significant new insights.

The future of MHT-ovarian cancer research

OCAC researchers note that clinician and patient confidence in using MHT offers great potential benefit to women with ovarian cancer, particularly those with high-grade serous carcinomas. In addition, MHT brings other benefits to postmenopausal women, including a reduction in the risk of hip fracture and colorectal cancer, and the heart-protecting effects of MHT use within four to six years of beginning menopause.

The OCAC study authors concluded: "These findings are helpful to understand the biology of the disease, and ultimately our goal is to help women diagnosed with ovarian cancer to live both longer and with a higher quality of life."