Managing menopausal symptoms and associated clinical issues in breast cancer survivors.

Managing menopausal symptoms and associated clinical issues in breast cancer survivors.

J Clin Endocrinol Metab. 2017 Aug 02;:

Authors: Santen RJ, Stuenkel CA, Davis SR, Pinkerton JV, Gompel A, Lumsden MA

Abstract
Objective: Review evidence to guide the management of menopausal signs and symptoms in women after breast cancer and make recommendations accordingly.
Evidence: Randomized controlled clinical trials, observational studies, evidence- based guidelines, and expert opinion from professional societies.
Background: Several symptoms and clinical problems associated with estrogen depletion -sleep disorders, vulvovaginal atrophy (VVA), vasomotor symptoms (VMS), mood changes, depressive symptoms, cardiovascular disease, osteopenia and osteoporosis- confront the estimated 9.3 million breast cancer survivors globally.
Recommendations: Following breast cancer, women should not generally be treated with menopausal hormone therapy or tibolone but should optimize lifestyle. Women with moderate to severe symptoms may benefit from mind-brain-behavior or non-hormone, pharmacologic therapy. The selective serotonin /noradrenaline reuptake inhibitors and gabapentenoid agents exert beneficial effects on VMS and quality of life. For osteoporosis, the panoply of non-hormonal agents is available. Treatment of VVA remains an area of unmet need. Low dose vaginal estrogen is absorbed in small amounts with blood levels remaining within the normal range but could potentially stimulate occult breast cancer cells, and although poorly studied, is not generally advised, particularly for those on aromatase inhibitors. Intravaginal DHEA and oral ospemiphene have been approved to treat dyspareunia, a symptom of VVA but safety after breast cancer has not been established. Vaginal laser therapy is being utilized for VVA but efficacy from sham-controlled studies is lacking. Therapies undergoing development for possible future use include lasofoxifene, neurokinin B inhibitors, stellate ganglion blockade, vaginal testosterone, and estetrol.
Conclusions: A variety of non-hormone options and therapies are available for treatment of estrogen -depletion symptoms and clinical problems after a diagnosis of breast cancer. Individualization of treatment is essential.

PMID: 28934376 [PubMed - as supplied by publisher]

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