# The Management of Menopause in Women with Philadelphia-Negative Myeloproliferative Neoplasms: Clinical Challenges and Therapeutic Considerations

## TL;DR

This paper reviews the challenges of managing menopause in women with myeloproliferative neoplasms and explores treatment options.

## Contribution

The paper provides a clinical algorithm and summarizes evidence for managing menopause in MPN patients.

## Key findings

- Menopause symptoms overlap with MPN symptoms, complicating diagnosis and treatment.
- Hormone replacement therapy poses thrombosis risks in MPN patients.
- Non-hormonal and supportive care strategies are proposed as alternatives.

## Abstract

Philadelphia-Negative Myeloproliferative neoplasms (MPNs) are chronic blood cancers that can be associated with significant symptoms. These can impact patients’ quality of life and thus require close management. In women, particularly those going through menopause, the symptom burden can increase. However, due to the crossover of symptoms between menopause and MPN, it can be difficult to delineate the two conditions in these patients. This is compounded by the lack of guidance around the use of hormone replacement therapy in MPN patients due to the potential risk of thrombosis. Our review aims to assess evidence to date around menopause and MPN and highlight potential therapy strategies to consider in these patients.

Philadelphia-Negative Myeloproliferative neoplasms (MPNs) are chronic clonal hematopoietic malignancies characterized by dysregulated myeloid proliferation, chronic inflammation, and an increased risk of thrombotic and hemorrhagic complications. In addition to disease-related morbidity, MPNs are associated with a substantial symptom burden that significantly impacts quality of life. Menopause is accompanied by hormonal changes that can produce symptoms overlapping with those of MPNs, complicating clinical assessment and management in affected women. This challenge is further compounded by the lack of disease-specific guidance on menopause management in women with MPNs and ongoing concerns regarding the thrombotic risk associated with hormone replacement therapy (HRT). This narrative review summarizes the current evidence on menopause in women with Philadelphia chromosome–negative MPNs, with particular focus on the safety and role of HRT, non-hormonal therapeutic alternatives, and supportive care strategies. We also propose a pragmatic clinical algorithm to support individualized menopause management in this high-risk population.