ABSTRACT
Hormone replacement therapy in women with gynecologic cancers is fraught with theoretical concerns that estrogen might have a deleterious affect upon survival. The disease sites for which this is a concern are breast, uterine corpus, and, to a smaller extent, ovarianmalignancies. Ninety percent of U.S. women will live to the climacteric age compared to only 30% just 200 years ago. The average woman can expect to spend at least 40% of her lifetime in the menopausal period. Attrition and aging of ovarian follicles result in the termination of the maturation of granulosa cells which are responsible for estrogen production. The sources of estrogen in the premenopausal woman are many and include the direct production of estradiol by the ovaries in addition to the extraglandular aromatization in adipose cells of androstenedione produced in the adrenal glands and ovary. The hallmark of menopause is the drop in ovarian production of estriol and testosterone. Whereas peripheral aromatization of other steroids is an additional source of estrogen for all postmenopausal women, this source is not sufficient in most women to prevent the symptoms characteristic of estrogen deprivation (Table 1).
