Endometrial hyperplasia, estrogen therapy, and the prevention of endometrial cancer

Endometrial hyperplasia is primarily caused by estrogen excess. Understanding the clinical situations in which excess unopposed estrogen may exist helps the clinician better predict which women are at risk for endometrial hyperplasia and cancer. In addition, such knowledge provides windows of opportunity for implementation of prevention strategies. The obesity epidemic has certainly contributed to the rising incidence of endometrial cancer in the United States and other developed countries. Delays in childbearing in combination with a younger age of diagnosis has also led to more women with pre-malignant or malignant endometrial lesions wishing to preserve fertility. Treatment of gynecological cancers may have a significant impact on women and their quality of life due to early menopause. In addition, many female cancers contain estrogen receptors. The question of the role of hormone replacement therapy in developing or stimulating cancers and its use for cancer survivors remains confusing, conflicting, and controversial. Understanding menopause and the benefits and risk of menopausal hormone use will help clinicians work with oncologists to respond to women’s menopausal concerns and improve quality of life for women at risk of or having survived cancer.