New recommendations for managing menopausal symptoms in breast cancer survivors

A large proportion of the world’s estimated 9.3 million breast cancer survivors experience menopausal symptoms or clinical manifestations of estrogen deficiency. A comprehensive review published in the Endocrine Society’s Journal of Clinical Endocrinology & Metabolism focuses on current and future approaches to management of menopausal symptoms after breast cancer.

Menopause is a normal part of a woman’s aging process but pre-menopausal women treated with chemotherapy can also develop premature menopause, and consequently, severe menopausal symptoms including sleep disorders, vulvovaginal atrophy (VVA), vasomotor symptoms (VMS), mood changes, depressive symptoms, cardiovascular disease, osteopenia, and osteoporosis. Hormone therapy may help relieve a woman’s menopausal symptoms but is not recommended for women who have had breast cancer.

“Following breast cancer, women should generally not be treated with menopausal hormone therapy but should instead focus on lifestyle modifications such as smoking cessation, weight loss, and regular physical activity,” said the study’s first author, Richard J. Santen, M.D., of the University of Virginia Health System in Charlottesville, Va. “Pharmacologic agents are also available to treat women with severe symptoms. The most important thing to remember is that therapy must be individualized based on each woman’s needs and goals.”

Santen and colleagues reviewed controlled clinical trials, observational studies, evidence-based guidelines, and expert opinion from professional societies to address the gap in treatment recommendations for management of menopausal symptoms after breast cancer.

The review’s recommendations include:

• Smoking cessation, weight loss (if indicated), limiting or avoiding alcohol, maintaining adequate levels of vitamin D and calcium, eating a healthy diet, and regular physical activity are suggested for all women with prior breast cancer
• Non-pharmacologic therapies for VMS such as cognitive behavioral therapy, hypnosis, and acupuncture may be helpful as are vaginal lubricants and moisturizers
• Several emerging approaches such as selective estrogen receptor modulators (SERMs), Tissue selective estrogen complex (TSECs), estetrol, and neurokinin B inhibitors show promise as useful agents to expand options for symptom relief with less breast cancer risk but have not yet been tested to confirm safety in women with prior breast cancer

Other authors of the study include: Cynthia A. Stuenkel of the University of California, San Diego in La Jolla, Calif.; Susan R. Davis of the School of Public Health and Preventative Medicine, Monash University in Australia; JoAnn V. Pinkerton of the University of Virginia in Charlottesville, Va.; Ann Gompel of Paris Descartes University in France; and Mary Ann Lumsden of the University of Glasgow School of Medicine, Dentistry, and Nursing in Scotland.

The study, “Managing Menopausal Symptoms and Associated Clinical Issues in Breast Cancer Survivors” is published online at https://academic.oup.com/jcem/article/4058051/Managing-menopausal-symptoms-and-associated, ahead of print.

About Endocrine Society

Endocrinologists are at the core of solving the most pressing health problems of our time, from diabetes and obesity to infertility, bone health, and hormone-related cancers. The Endocrine Society is the world’s oldest and largest organization of scientists devoted to hormone research and physicians who care for people with hormone-related conditions.

The Society has more than 18,000 members, including scientists, physicians, educators, nurses, and students in 122 countries. To learn more about the Society and the field of endocrinology, visit our site at www.endocrine.org. Follow us on X (formerly Twitter) at @TheEndoSociety and @EndoMedia.