Menopausal hormone therapy prescription and ovary-sparing surgery in women with pre-menopausal endometrial cancer: a Swedish PremEnCa study.
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OBJECTIVE: The use of ovary-sparing surgery and menopausal hormone therapy after endometrial cancer is controversial, requiring a balance between a presumed increased risk of recurrence and the well-known adverse effects of premature menopause. Studies on this topic, specifically in pre-menopausal women, are scarce and heterogeneous. This nationwide, population-based, retrospectively conducted cohort study aimed to describe the use of ovary-sparing surgery and post-treatment menopausal hormone therapy in pre-menopausal women with endometrial cancer and to analyze related factors. METHODS: The study population comprised women aged ≤50 years diagnosed with endometrial cancer and registered in Sweden between 2010 and 2021. Data from validated Swedish registers were supplemented with manual review of medical records. Factors associated with ovary-sparing surgery were presented separately. Menopausal hormone therapy prescription was defined as at least 1 dispensing within 5 years of diagnosis. Cumulative incidence of menopausal hormone therapy prescription over 5 years was presented by sub-group. Multivariable regression was used for assessing potential factors affecting prescription patterns and included all endometrial cancer cases. RESULTS: The study included 731 women, of whom 42 (5.7%) underwent ovary-sparing surgery. Cumulative incidence of menopausal hormone therapy prescription was 45% for women aged 18 to 39 years, 27% for those aged 40 to 44 years, and 15% for those aged 45 to 50 years (p <.001). Among women aged <40 years with low-grade endometrioid adenocarcinoma, stage I to II, 38.1% received neither ovary-sparing surgery nor menopausal hormone therapy. Multivariable regression analyses showed that younger age, body mass index <30 kg/m2, International Federation of Gynecology and Obstetrics stage I to II, and later year of diagnosis were independently associated with increased prescription of menopausal hormone therapy. CONCLUSIONS: This study demonstrates that the use of ovary-sparing surgery and menopausal hormone therapy remains low, even in young women with low-risk endometrial cancer. Menopausal hormone therapy appears to be under-utilized, which may be attributable to inconclusive evidence regarding its impact on recurrence risk, whereas the long-term adverse consequences of premature menopause are well known.