Many patients with gynecologic malignancies experience some significant discomfort associated with menopause after treatment – menopausal syndrome, which seriously affects patients’ physical needs and reduces their quality of life. Clinical practice has proven that sex hormone replacement therapy (HRT) can significantly reduce these symptoms. However, compared to foreign countries, sex hormone replacement therapy for patients with gynecologic malignancies is rarely applied in China. Do gynecologic tumor patients need to use sex hormone replacement therapy after treatment or not? And can sex hormone replacement therapy be used at the same time? Here we combine clinical and experimental research experience at home and abroad to answer your questions from various aspects. First, the survival rate of patients with gynecologic malignancies has increased, and there are higher requirements for survival quality. The incidence of the three major gynecological malignant tumors (cervical cancer, endometrial cancer and ovarian cancer) are all on a younger trend. The incidence of cervical cancer has two peak ages: 30-35 years old and 60-65 years old; 20-25% of patients with endometrial cancer have premenopausal onset and 5% of patients are younger than 40 years old; 40% of ovarian epithelial cancer occurs in women aged 30-50 years old and the median age of onset is 48.9 years old. Coupled with the increasing standardization and improvement of current treatment protocols, the survival rate of patients with gynecomas has been greatly improved. Patients’ lives can be prolonged, then further improvement of the quality of survival is not only the wish of patients’ hearts, but also a problem that doctors urgently need to solve. Second, the ovarian function of patients with gynecological malignancies is damaged to different degrees after treatment, and then a series of discomfort occurs. Young patients with early stage cervical cancer (before IIa) are mainly treated with radical hysterectomy (even hysterectomy alone can cause early decline of ovarian function) and some need adjuvant radiotherapy. post-IIb patients are treated with radical radiotherapy or combined with simultaneous chemotherapy. The radiation in radiotherapy has obvious effects on the ovaries, leading to premature ovarian failure or impaired ovarian function, while the radiation can cause damage to the vaginal mucosa, resulting in vaginal stenosis or even total vaginal atresia, which seriously affects the patient’s quality of life. Endometrial cancer mainly adopts total hysterectomy with bilateral adnexal resection. Ovarian cancer patients mainly undergo comprehensive staging with tumor cell reduction. It can be seen that all three major gynecological malignancies have impaired ovarian function after treatment, and coupled with the damage caused by radiotherapy, patients’ quality of life is significantly reduced, mainly manifesting as menopausal syndrome. III. What is menopause syndrome? Menopause syndrome, also known as perimenopausal syndrome, refers to a series of syndromes caused by fluctuations or decreases in sex hormones in women around menopause, mainly due to dysfunction of the autonomic nervous system, accompanied by neuropsychological symptoms. Menopause can be divided into two types: natural menopause and artificial menopause. Natural menopause refers to the permanent cessation of menstruation due to the physiological depletion of follicles in the ovaries at a certain age. Artificial menopause is caused by surgical (oophorectomy, hysterectomy and/or total adnexal resection) or radiological destruction of ovarian function. The main manifestations are: 1. vasodilatory symptoms: hot flashes sweating; 2. genitourinary atrophy symptoms: dryness infection; 3. neurological: anxiety depression sleep disturbance dementia; 4. skeletal: osteoporosis increased bone loss; 5. cardiovascular disorders. Patients with gynecological malignancies will inevitably develop menopausal syndrome after surgery or radiotherapy for ovarian deactivation and a sharp drop in estrogen levels, with symptoms appearing earlier and to a more dramatic degree than natural menopause. Another is the side effects of radiotherapy and chemotherapy, such as generalized bone and joint pain, dizziness and weakness, etc. These symptoms may be more severe because they overlap with the symptoms caused by low estrogen levels. There are also vaginal adhesions, vaginal narrowing and loss of elastic mucosa, low resistance, and recurrent infections caused by radiotherapy, all of which affect the quality of sexual life of patients. Sex hormone replacement therapy can compensate for the lack of ovarian function at the source and has definite effects on menopausal syndrome. Fourth, sex hormone replacement therapy is very effective, but why is it so little used in China? 1. Studies in recent years have shown definite results that hormone replacement therapy will change the endocrine environment in the body and prolong the stimulation of estrogen on the glandular epithelium, which will lead to cellular malignancy and increase the risk of women suffering from breast cancer, endometrial cancer, hypertension and diabetes, so too much emphasis has been placed on the cautious use of hormone replacement therapy. 2. In China, the treatment of malignant tumor patients only takes the reduction of recurrence rate and mortality as the main goal of clinical treatment, but not the survival quality of patients as an important index to evaluate the treatment effect. 3. There is no clear conclusion so far on whether hormone replacement therapy has any effect on the prognosis of patients with malignant tumors, especially because the instructions of some hormone replacement drugs mostly mention that they are prohibited or used with caution in gynecological malignant tumors, so doctors often have scruples when considering the treatment plan, think about it and finally give up using it. For patients with gynecologic malignancies, surgery and radiotherapy often lead to a sharp drop in sex hormone levels within a short period of time, thus making them more prone to severe menopausal syndrome. In order to improve the survival quality of these gynecological malignant tumor patients, we should emphasize the wide application of hormone replacement, and should not avoid the use of sex hormones because of choking. V. Is sex hormone replacement therapy safe for patients with gynecological malignancies? Comprehensive domestic and foreign studies show that: 1. After using sex hormone replacement therapy for cervical cancer, there is no difference in the recurrence rate and overall survival rate after 5 years of follow-up, and the use of HRT not only controls the symptoms of low estrogen level, but also reduces some complications caused by radiotherapy in the bladder, rectum and vagina, which obviously improves the survival quality of patients. Cervical cancer is not a hormone-dependent tumor, so it is safe to use HRT after cervical cancer treatment, especially after treatment of squamous carcinoma of the official neck. For cervical adenocarcinoma, there are fewer studies on HRT because its onset stage is similar to that of endometrial cancer, so the treatment of endometrial cancer should also be referred to. 2.The occurrence of endometrial cancer is related to estrogen, but there is no experimental evidence that HRT after endometrial cancer increases the risk of recurrence of endometrial cancer, and the disease-free survival is high after taking HRT; the potential danger of estrogen is carefully considered for those with obvious menopausal syndrome in low-risk early endometrial cancer, and it should be safe to use HRT especially in small doses for short-term use. 3. There is no consensus on ovarian cancer research, but studies have shown that the use of HRT has no significant effect on recurrence and metastasis in most ovarian cancer patients, and the quality of life can be improved after the use of hormones. For a small number of ovarian malignant tumors such as ovarian granulosa cell tumor, it is not suitable for sex hormone replacement therapy because it is a hormone-dependent tumor. VI. Sex hormone replacement therapy for gynecological malignancies – the principle of individualization Since HRT is a very effective method for treating menopausal syndrome caused by tumor treatment, it has no obvious adverse effects on patients after treatment for gynecological malignancies, especially for patients with severe menopausal syndrome, the risk of short-term estrogen replacement therapy Especially for patients with severe menopausal syndrome, the risk of short-term estrogen replacement therapy is extremely low, but it will significantly improve the quality of life of patients. Therefore, we suggest that: 1. For patients with no obvious symptoms after gynecological malignant tumor surgery, observation and regular follow-up can be done according to medical advice. 2. 2. For patients with mild menopausal syndrome, Chinese medicine can be used to regulate them first. According to the principles of Chinese medicine, menopausal syndrome is characterized by qi stagnation and blood stasis, deregulation of the heart and veins, deficiency of the heart and kidneys, and disharmony of the spleen and stomach. Then the corresponding principles of TCM treatment are to unblock the blood vessels and channels, nourish Yin and tonify the kidneys, harmonize the spleen and stomach, and activate blood stasis. Patients should consult a TCM practitioner to adopt the correct dialectical prescription for medication. 3, for patients who still have uncomfortable symptoms after Chinese medicine regulation, Livermin is recommended for treatment. Livermin tablets a natural plant medicine, extracted from the medicinal plant black asclepias. The product has been safely used in the European and American markets for more than 40 years, and a large number of authoritative preclinical and clinical medical studies conducted since its development have confirmed the effectiveness and good tolerability of Livermin tablets, which can effectively relieve perimenopausal syndrome, especially in relieving hot flashes, sweating, sleep disorders, mood disorders and other aspects widely recognized by domestic and international clinical medical research. 4. For patients who have obvious symptoms that have a great impact on their lives, hormone replacement therapy should be tried and closely observed at the same time. Regarding the plan of hormone replacement therapy, the physician should make a decision by weighing the patient’s clinical symptoms and various examination and laboratory results. Hormone replacement therapy must be closely observed, especially for patients after endometrial cancer treatment. Because endometrial cancer is a hormone-dependent tumor, it was once listed as a contraindication to HRT in the past, but now studies have found that hormone replacement therapy can be used to relieve perimenopausal symptoms in patients with low-risk early-stage endometrial cancer, based on successful surgical treatment, without high-risk recurrence factors, and without contraindications to the application of estrogen. Therefore, HRT treatment after endometrial cancer treatment is detailed below. ①Each person needs to establish a follow-up observation medical record to record the observation condition. ②Do a comprehensive physical examination: gynecological examination; palpation and mammography; liver and pelvic ultrasound; liver and kidney function tests; determination of methemoglobin, carcinoembryonic antigen 19-9 and CA-125; vaginal exfoliative cytology to check cancer cells and ovarian function; measurement of blood pressure; electrocardiogram. ③The examination results were within the normal range, and HRT was given according to individual conditions. the principles of drug administration were sequential administration of multiple estrogens; each estrogen was applied according to the degree of symptom relief; the drug dose was individualized, and each patient had his or her own minimum dose for symptom relief; the drug was administered continuously or intermittently for 2-4 years according to specific conditions. ④ Regular comprehensive physical examination and test follow-up. On the one hand, we should observe whether there is any recurrence of the disease itself and whether there is any abnormality in the systemic metabolism; on the other hand, we should observe the patient’s breast condition to prevent mastopexy reaction. Anyone receiving sex hormone replacement therapy should have an outpatient review or letter visit once every 3 months, and a gynecological examination once every 6 months, as well as ultrasound and endometrial biopsy when necessary. Breast examination should pay attention to the presence of lobular hyperplasia or lumps, and the monitoring of heart, liver, biliary and blood functions. VII. Contraindications to sex hormone replacement therapy 1. Low-grade malignant endometrial mesenchymal sarcoma, which is a hormone-sensitive tumor, often occurs due to exogenous and endogenous estrogen overstimulation. 2. Ovarian granulosa cell tumors, which are hormone-dependent tumors, secrete estrogen as their important clinical feature, but the expression of estrogen and progesterone receptors in ovarian granulosa cell tumors is relatively low, and their sensitivity to sex hormones is weak, so sex hormone replacement therapy should not be used. In conclusion, for patients with premenopausal or early menopausal gynecologic malignancies, menopausal syndrome often appears after treatment. Hormone replacement therapy is effective in relieving menopausal syndrome. For the majority of gynecologic malignancies, clinical studies at home and abroad have not found that hormone replacement therapy has adverse effects on the prognosis of these patients. It is true that sex hormone replacement therapy has certain risks, but its use in patients with gynecologic malignancies has more advantages than disadvantages, so it is important not to look ahead and choke on it. For patients with obvious menopausal symptoms and significantly reduced quality of life, doctors should give different treatments for different symptoms on the basis of patients’ fully informed consent, with particular emphasis on individualized treatment. It can be said that under the premise of rational application, sex hormone replacement therapy is a blessing for patients with gynecological malignancies.