Taking the findings of the abovementioned studies into account, systemic HT is generally not recommended to treat VMS in patients with hormone-sensitive cancers or estrogen receptor positive tumors (such as certain breast, endometrial, and ovarian cancers).4,47 Low-dose vaginal estradiol is now a feasible consideration as second-line therapy for urogenital symptoms in patients with history of breast cancer, but it is not an effective treatment for VMS.121 In patients with active prostate cancer, testosterone therapy should be avoided. This evidence concerns the gene ESR1 and breast carcinoma.