Menopausal hormone therapy and comprehensive postmenopausal care in gynecologic cancer survivors: A position paper from the FIGO Committee on Women at Menopausal Age

Recent advances in cancer screening, diagnosis, and treatment have greatly improved survival rates among women with gynecologic cancers. More survivors now live long enough to experience treatment-related menopause. Vasomotor symptoms, genitourinary syndrome of menopause, sexual dysfunction, sleep issues, and long-term risks from estrogen deficiency can seriously impact quality of life. Despite increased survival, managing menopausal symptoms remains difficult, as concerns about cancer recurrence and hormone therapy safety often result in inconsistent or insufficient treatment. This article explores clinical considerations for menopausal hormone therapy (MHT) in women with a history of gynecologic cancer. It reviews evidence on the safety of MHT after vulvar, vaginal, cervical, uterine, and ovarian cancers, providing an overview of tumor histology, stage, and hormonal sensitivity. It also synthesizes observational studies, systematic reviews, and international guidelines to help clinicians deliver menopausal care to cancer survivors. Current evidence suggests that systemic MHT may be suitable for carefully chosen survivors of non-hormone-dependent gynecologic cancers, including most vulvar, vaginal, cervical, and epithelial ovarian cancers. Patients with hormonally sensitive tumors should generally avoid systemic MHT, while local vaginal hormonal administration and non-hormonal options remain important in these cases. Given the disproportionate burden of gynecologic cancers in low- and middle-income countries, where younger women face increased risks of treatment-induced menopause and limited survivorship resources, this paper emphasizes context-specific, resource-aware strategies to promote equitable care. By enhancing personalized and evidence-based decision-making, we aim to improve quality of life for women during menopause after cancer treatment, while ensuring safe, fair, and widely applicable survivorship approaches.