Barriers to prescription of hormonal contraception and hormone replacement therapy in gynecological cancer survivors: Results of a survey and literature review
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Abstract
Background
The incidence of gynecological cancers in premenopausal women is increasing, highlighting issues related to Hormonal Contraception (HC) and Hormone Replacement Therapy (HRT). However, the presence of hormonal receptors in many gynecological cancers complicates HC and HRT prescriptions.
Objective
To identify barriers experienced by gynecologists in prescribing HC and HRT to gynecological cancer survivors, with a secondary objective of conducting a literature review on the safety of these prescriptions.
Methods
A nationwide survey was conducted among Portuguese gynecologists, including questions about their prescribing practices for HC and HRT in gynecological cancer survivors. For the narrative review, the authors searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and SCOPUS from January 2019 to April 2024. The included studies encompassed gynecological cancer survivors using HC or HRT, detailing tumor histologic type and clinical outcomes.
Results
185 gynecologists participated in the questionnaire: 151 general gynecologists (81.6 %) and 34 oncology gynecologists (18.4 %). Of these, 49.7 % and 55.1 % had prescribed HC and HRT, respectively. Cervical cancer had the highest prescription rate, followed by vulvar and vaginal cancer, with fewer prescriptions for ovarian/fallopian tube, endometrial, and uterine corpus (non-endometrial) cancers. Older age and specialization in gynecologic oncology significantly predicted HC and HRT prescriptions (p < 0.05). Uncertainty was the main reason for not prescribing HC/HRT. A narrative review confirmed the safety of prescribing for specific tumor subtypes.
Conclusion
The survey findings highlight an occasionally unfounded apprehension regarding the use of HC and HRT among gynecological cancer survivors. This underscores the crucial need for enhanced education on these matters.
背景：绝经前妇女妇科癌症的发病率正在上升，这突出了与激素避孕（HC）和激素替代治疗（HRT）相关的问题。然而，在许多妇科癌症中激素受体的存在使HC和HRT处方复杂化。目的：了解妇科医生在为妇科癌症幸存者开具HC和HRT处方时遇到的障碍，并对这些处方的安全性进行文献综述。方法：对葡萄牙妇科医生进行了一项全国性的调查，包括他们对妇科癌症幸存者的HC和HRT处方实践的问题。对于叙述性综述，作者检索了MEDLINE、Embase、Cochrane Central Register of Controlled Trials和SCOPUS，检索时间为2019年1月至2024年4月。纳入的研究包括使用HC或HRT的妇科癌症幸存者，详细说明肿瘤的组织学类型和临床结果。结果：185名妇科医生参与问卷调查，其中全科妇科医生151名（81.6%），肿瘤科妇科医生34名（18.4%）。其中，分别有49.7%和55.1%的人开了HC和HRT。宫颈癌的处方率最高，其次是外阴癌和阴道癌，卵巢/输卵管癌、子宫内膜癌和子宫体癌（非子宫内膜癌）的处方率较低。结论：调查结果强调了在妇科癌症幸存者中使用HC和HRT的偶尔毫无根据的担忧。这突出了加强这些问题教育的关键必要性。
期刊介绍：
Formerly known as Journal de Gynécologie Obstétrique et Biologie de la Reproduction, Journal of Gynecology Obstetrics and Human Reproduction is the official Academic publication of the French College of Obstetricians and Gynecologists (Collège National des Gynécologues et Obstétriciens Français / CNGOF).
J Gynecol Obstet Hum Reprod publishes monthly, in English, research papers and techniques in the fields of Gynecology, Obstetrics, Neonatology and Human Reproduction: (guest) editorials, original articles, reviews, updates, technical notes, case reports, letters to the editor and guidelines.
Original works include clinical or laboratory investigations and clinical or equipment reports. Reviews include narrative reviews, systematic reviews and meta-analyses.
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