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Borderline Ovarian Tumours: CNGOFS Guidelines for Clinical Practice – Hormonal Contraception and MHT/HRT After Borderline Ovarian Tumour

Christine Rousset-Jablonski 1, Patricia Pautier 2, Nicolas Chopin 3, Fabrice Lecuru 4, Isabelle Ray-Coquard 5

DOI: 10.1016/j.gofs.2020.01.021

Abstract
Contraceptive options and menopause management are frequent clinical issues among women previously treated for a borderline ovarian tumour (BOT).

Objectives: To synthesize knowledge on BOT and risk related to hormonal contraception and to menopausal hormone therapy (MHT), and to propose recommendations on contraception and MHT after BOT treatment.

Methods: Systematic review of the literature about hormonal contraception and BOT and on MHT and BOT was conducted on PubMed/Medline and the Cochrane Library.

Results: There are no data concerning hormonal contraception after BOT. Current or previous oral contraception is associated with a trend towards decreased risk of serous BOT. Mucinous BOT risk is not or slightly decreased by oral contraception. Hormonal contraception is thus not contraindicated in women previously treated for a BOT (Grade C). MHT is associated with a trend towards increased risk of serous BOT. No relation was found between MHT and risk of mucinous BOT. Serous BOTs with high-risk histological criteria (micropapillary pattern, stromal microinvasion or peritoneal implants) are at high risk of invasive potentially hormone-sensitive recurrence. Hence, caution is needed in the decisions of using MHT after serous BOT with one of these high-risk histological criteria, and MHT should be discussed on a case to case basis. MHT can be prescribed without restriction in women previously treated for mucinous and serous BOT without high-risk histological criteria (Grade C).

Conclusion: Hormonal contraception can be used after BOT. The histological characteristics of the tumour must be taken into account when deciding on the use of HRT/THM.