Managing vasomotor symptoms in women after cancer

Abstract

Women with estrogen-sensitive cancer or survivors of these neoplasms are generally not candidates for systemic menopausal hormone therapy or tibolone for the treatment of bothersome vasomotor symptoms (hot flashes or night sweats). However, menopausal symptoms negatively affect quality of life and need to be addressed by clinicians. For mild vasomotor symptoms, optimizing lifestyle changes or mind–brain behavior may be sufficient. For women with moderate to severe vasomotor symptoms unresponsive to these measures, non-hormone pharmacologic therapy may be needed. Randomized controlled trials have shown efficacy for vasomotor symptoms with selective serotonin reuptake inhibitors (paroxetine, citalopram, and escitalopram) and serotonin–norepinephrine reuptake inhibitors (venlafaxine and desvenlafaxine), as well as gabapentin, pregabalin, and clonidine. Therapies in development include neurokinin B inhibitors (neurokinin 3 receptor), stellate ganglion blockade, and a natural estrogen, estetrol. Individualizing therapy is important. As the physiology of menopausal hot flashes becomes better understood, it will drive development of future non-hormone pharmacotherapies.

摘要

患有雌激素敏感性癌症的妇女或这些肿瘤的幸存者通常不适合全身应用更年期激素疗法或替勃龙治疗烦人的血管舒缩症状（如潮热或盗汗）。但是, 更年期症状会对生活质量产生负面的影响, 需要临床医生进行治疗。对于轻度的血管舒缩症状, 可能通过改变生活方式或思维方式就能够达到治疗的效果。对于应用这些治疗方法无效果的中度至重度血管舒缩症状的女性, 可能需要非激素药物治疗。随机对照试验表明, 应用选择性5-羟色胺再摄取抑制剂（帕罗西汀, 西酞普兰和依西酞普兰）和5-羟色胺-去甲肾上腺素再摄取抑制剂（文拉法辛和去甲文拉法辛）以及加巴喷丁, 普瑞巴林和可乐定对血管舒缩症状有效。还在研究中的治疗方法包括神经激肽B抑制剂（神经激肽3受体）, 星状神经节阻滞剂和天然雌激素, 雌四醇。个体化的治疗非常重要。在生理发生机制上对更年期潮热越来越多的了解, 将推动未来非激素药物疗法的发展。

Keywords:

• Non-hormone pharmacotherapies
• menopause
• selective serotonin reuptake inhibitor
• serotonin–norepinephrine reuptake inhibitor
• gabapentin
• clonidine
• hot flashes
• neurokinins
• estetrol

Potential conflict of interest

J-VP: none for past 12 months. RJS: research funding from Panterhei Bioscience.

Additional information

Funding

Nil.