(028) Monitored Hormone Therapy for Sexual Dysfunction in Menopausal Breast Cancer Survivors: Are Benefits Greater than Risks?

Abstract Introduction Patients and practitioners are apprehensive regarding the use of hormone therapy (HT) after breast cancer, as traditionally this is considered a contraindication due to concerns that hormones could stimulate cancer recurrence and thromboembolic events. In addition, clinicians are fearful of litigation should they prescribe HT. Therefore, few breast cancer survivors receive hormonal treatment for genitourinary syndrome of menopause (GSM). Objective This is a chart review of menopausal breast cancer survivors presenting to a single clinic for sexual dysfunction and treated using monitored HT. Methods Charts from breast cancer survivors 8/06/2007-7/31/2025 were reviewed to identify menopausal women prescribed HT in our clinic. New patients undergo a biopsychosocial assessment including history, completion of validated questionnaires, baseline hormone blood tests, vulvoscopy with photography, and cotton-tipped swab testing. HT consists of systemic non-oral estradiol (E2), oral progesterone and transdermal testosterone, and local intravaginal DHEA or estradiol and compounded vestibular estradiol/testosterone, bioidentical sex steroid hormones. Monitored HT includes regular blood tests aimed at achieving target values of E2 (25-50 pg/mL), progesterone (1.0-2.0 ng/mL), and calculated free testosterone (cFT) (0.6-0.8 ng/dL), vulvoscopic examinations to assess changes in genital appearance and function, and patient response to therapy. Results 16 patients, mean age 59.8 years (range 50-71), were included, with mean follow-up of 3.7 years (range 0.1-13.4). Sexual health concerns at presentation included low desire (81%), low arousal (75%), muted/absent orgasm (75%), and dyspareunia (56%). Mean baseline total Female Sexual Function Index score was 14.0 (range 2.0-30.8) with mean scores of desire, arousal, lubrication, orgasm, satisfaction, and pain domains of 2.4, 2.4, 2.2, 2.5, 2.6, and 1.9, respectively. Mean score for the Sexual Distress Scale-Revised was 25.4 and Patient Health Questionnaire-9 was 5.0. Mean baseline hormone blood test values and most recent values following HT are in Table 1. Vulvoscopic findings revealed less clitoral atrophy, labial resorption, urethral telescoping and minor vestibular gland tenderness/erythema, with return of vaginal rugae (Fig. 1). 100% of patients stated that their GSM symptoms had improved on HT, thereby improving their quality of life. While on monitored HT, there was one breast cancer recurrence treated by lumpectomy, no thromboembolic events or major adverse cardiovascular events; each patient continued to work with her oncologist. Conclusions There appears to be insufficient data to conclude that HT is a contraindication for breast cancer survivors, based on reviews by Ugras and Rahman (2021) and Bluming (2022). Our experience has shown that select breast cancer survivors can undergo monitored HT with hormone blood tests approaching target values, positive changes on vulvoscopy, and improvement in sexual function. Most importantly, menopausal breast cancer survivors deserve to have the option to weigh treatment risks and benefits to address their sexual health issues and improve their quality of life. Disclosure No.