Management of menopausal symptoms in patients with uterine cancer remains clinically challenging [1,2]. As uterine cancer is typically managed surgically with hysterectomy in combination with oophorectomy, premenopausal patients experience abrupt estrogen deprivation and surgical menopause. These patients often develop acute menopausal symptoms including hot flashes and vaginal dryness [1,3,4]. While older, postmenopausal, patients will not experience the abrupt hormonal alterations of younger, premenopausal, individuals who undergo oophorectomy, these patients are frequently receiving hormonal therapy which is often interrupted when uterine cancer is diagnosed. As the prognosis of patients with uterine cancer is often excellent, management of both the acute sequelae of menopause as well as the longer term effects of estrogen deprivation have an important influence on long term health and quality of life [5,6].

Estrogen replacement therapy (ERT) is the most effective treatment for the management of vasomotor and genitourinary symptoms [7,8], as well as reducing future risks of cardiovascular diseases and bone loss [9]. According to guidelines from the National Comprehensive Cancer Network (NCCN) and several menopause-related societies, ERT for uterine cancer patients should be considered in patients with early-stage, low-grade endometrial cancer [7,9,10]. Although ERT does not affect recurrence risk in the population, there is often concern among healthcare providers and patients that estrogen may stimulate estrogen-sensitive cancers [1,10,11]. Given concerns about the safety of ERT, non-hormonal medications including antidepressant or anticonvulsant agents are often used as an alternative to estrogen-based therapy, even though they only affect short-term symptoms [3,7,9].

To date, there is limited research describing the use of ERT and non-hormonal alternatives in women with uterine cancer. The objective of this study was to examine the trends in the use of systemic ERT as well as non-hormonal drugs among both pre- and postmenopausal patients with uterine cancer. We first explored trends over time in the use of hormonal and non-hormonal treatments, and second, assessed the influence of a diagnosis of uterine cancer on receipt of these therapies.