Hormone replacement therapy and ovarian cancer

Hormone replacement therapy (HRT) can cause a small increase in the risk of developing certain types of ovarian cancer, though this risk depends on how long it is taken for and typically goes back down after you stop taking it. HRT can often be used safely following a diagnosis to maintain quality of life and manage symptoms of menopause. It’s important to speak to a specialist in menopause care to help you weigh up your personal risks and benefits and to explore your options. 

What is hormone replacement therapy (HRT)?

Hormone replacement therapy, often called HRT, is a treatment used to help replace hormones that the body is no longer making enough of. It is most commonly used during perimenopause and menopause, when levels of oestrogen and progesterone fall. HRT can help ease symptoms like hot flushes, night sweats, sleep problems, mood changes and vaginal dryness, improving quality of life for many people. It also helps to maintain muscle strength and reduce the risk of osteoporosis. HT can be given orally (as tablets) or through the skin (as patches, gels, or sprays, and the type and dose depend on individual needs and personalised medical advice.

Alongside this, it’s also possible to use a local oestrogen cream to help improve Genitourinary Syndrome of Menopause (GSM) which affects the majority of menopausal women and causes vaginal dryness, burning, itching, pain during sex, and frequent infections (UTIs). This can usually be used even if systemic (whole body) HRT isn’t advised.

Some women also find that testosterone replacement can help with libido, mood and energy levels but this has to be prescribed by a specialist doctor.

Even if one option isn’t suitable for you and your current situation, there will most likely be something a specialist doctor can do to help improve your menopause symptoms so don’t suffer alone.

What is Combined HRT?

Combined HRT is a type of hormone replacement therapy that contains both oestrogen and progesterone, or a progesterone-like hormone called progestogen. It is usually prescribed for people who still have a womb: Oestrogen makes the womb lining thicken, and progesterone is needed to help stop it getting too thick, so reducing the risk of womb cancer. However, some people do still take progesterone even if they have had their womb removed as it can improve sleep, reduce anxiety, and help with mood. Combined HRT can be taken continuously or in cycles, depending on menopausal stage and symptoms, and it can help ease common menopause symptoms like hot flushes, sleep problems and mood changes.

What is Oestrogen-only HRT?

Oestrogen-only HRT is a type of hormone replacement therapy that contains just oestrogen. It is usually prescribed for people who have had their womb removed, as they don’t need the progesterone to reduce the thickness of their womb lining. Oestrogen-only HRT can help relieve menopause symptoms such as hot flushes, night sweats, low mood and vaginal dryness. It comes in several forms, including patches, gels, and sprays), and the most suitable option should always be discussed with a healthcare professional.

HRT vs hormone therapy

The terms HRT and hormone therapy are often used interchangeably, but they can mean slightly different things depending on the context. HRT, or hormone replacement therapy, usually refers to treatment used to ease perimenopause or menopause symptoms by replacing hormones like oestrogen and progesterone that the body is producing less of. Hormone therapy is a broader term that can describe the use of hormones for different medical reasons, including menopause, gender-affirming care, or some cancer treatments. So, HRT is a type of hormone therapy, but not all hormone therapy is HRT.

What is HRT used for?

HRT is used mainly to help manage symptoms of perimenopause or menopause by replacing hormones that the body is no longer producing in sufficient amounts. This could be due to natural menopause, or due to having your ovaries removed due to gynaecological issues or risk-reducing surgery.

HRT can sometimes be used to help manage side effects after ovarian cancer treatment, particularly symptoms of an early or sudden menopause caused by surgery or chemotherapy. For many people, HRT can significantly improve qualitity of life. Whether HRT is suitable after ovarian cancer depends on factors like the type of ovarian cancer, stage, hormone sensitivity and individual medical history, so it is always something that needs careful discussion with a specialist cancer team and a menopause specialist so you can make a decision that is right for you.

Does hormone replacement therapy increase the risk of developing ovarian cancer?

Increased risk whilst taking HRT

Yes, hormone replacement therapy can slightly increase the risk of developing ovarian cancer, but it is important to note a few things when considering this risk.

Research shows that both combined HRT (oestrogen plus progestogen) and oestrogen-only HRT are associated with a small increase in ovarian cancer risk, particularly while HRT is being used and for a short time after stopping it. This increased risk gets bigger the longer HRT is used. However, it does reduce over time once HRT is stopped.

Increased risk of other cancers

HRT slightly increases the risk of some cancers, but the risk is small. For most people, the benefits will outweigh the risks.

HRT can increase the risk of:

Breast cancer

Ovarian cancer

Womb cancer (Oestrogen-only HRT)

Oestrogen-only HRT increases the risk of womb cancer. This risk rises the longer HRT is used and can continue for several years after treatment stops. Because of this, oestrogen-only HRT is usually only prescribed to people who have had a hysterectomy.

Other ovarian cancer risk factors

There are many other ovarian cancer risk factors including age, family history and lifestyle. You can read more about the ovarian cancer risk factors here.

How common is developing ovarian cancer after HRT?

Taking hormone replacement therapy (HRT) slightly increases the risk of ovarian cancer. Research suggests this amounts to around one extra case for every 1,000 people who use HRT for five years. The overall risk remains low.

For perspective, more cases of ovarian cancer are thought to be linked to being overweight than to taking HRT.

HRT after an ovarian cancer diagnosis

Most women with ovarian cancer can safely take HRT. It might not be suitable for all women with ovarian cancer so it’s important that you discuss taking HRT with your medical team or a menopause specialist before making any decisions.

Are there alternatives to hormone replacement therapy?

Whilst there are no direct alternatives to HRT, there are other options that may help symptoms of menopause.

Clonidine is a prescription medicine that can help reduce hot flushes and night sweats. Unlike HRT it doesn't affect hormone levels, so unlike HRT it does not increase the risk of breast cancer.

Certain anti-depressants have been found to reduce hot flushes.

Cognitive Behavioural Therapy (CBT) has been shown to reduce hot flushes and improve sleep.

Local (vaginal) oestrogen cream is effective at treating symptoms of Genitourinary Syndrome of Menopause (GSM) including vaginal dryness, pain during sex and frequent UTIs, and for most women can be used even if they are not able to take systemic HRT.

It's a good idea to ask a GP or pharmacist for advice if you're thinking about using a complementary therapy.

Herbal remedies that are sometimes taken for menopause symptoms include:

• evening primrose oil
• black cohosh
• angelica
• ginseng
• St John's wort
• red clover

However, these can come with their own side effects and interact with other medications - so it's important to consult a medical practitioner before taking any supplements or complementary therapies.

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