Managing menopausal symptoms after cancer

Abstract

The joint burden of cancer and menopause impacts millions of women globally. This review provides an approach to management of menopausal symptoms after cancer in all settings. This includes an overview of current evidence for both hormonal and non-hormonal treatments for vasomotor symptoms and vaginal dryness after cancer. Systemic menopausal hormone therapy provides symptom control and may be used after most cancers but should be avoided after estrogen receptor-positive breast cancer and after some other estrogen-dependent cancers. Non-hormonal therapies have been minimally studied in women after a cancer diagnosis and, where they have been studied, it is usually in women with breast cancer. Non-hormonal methods to manage vasomotor symptoms include cognitive behavioral therapy, hypnosis, selective serotonin reuptake inhibitors, serotonin noradrenaline reuptake inhibitors, clonidine, and gabapentin. Vaginal estrogen may be useful to address vaginal dryness. However, safety data in breast cancer patients are still lacking and there is currently no consensus. Lubricants may also help with pain with sexual activity. Management of menopausal symptoms after cancer may be challenging and should include information about induced menopause and possible symptoms as well as available treatments. Management then requires a holistic and multidisciplinary approach with individualized care.

摘要

癌症和绝经的共同负担影响着全球数百万女性。这篇综述提供了一种在所有情况下癌症治疗后绝经症状的管理方法。这包括管理癌症治疗后血管舒缩症状和阴道干燥的激素和非激素治疗的最新证据概述。全身绝经激素疗法可控制症状, 可在大多数癌症治疗后采用, 但雌激素受体阳性的乳腺癌和某些雌激素依赖性的癌症应避免采用。在诊断癌症后, 对女性非激素疗法的研究最少, 而在已有的研究中, 非激素疗法通常用于乳腺癌女性。管理血管舒缩症状的非激素方法包括认知行为疗法、催眠、选择性5-羟色胺再摄取抑制剂、5-羟色胺去甲肾上腺素再摄取抑制剂、可乐定和加巴喷丁。阴道雌激素可能有助于缓解阴道干燥。但是, 仍然缺乏乳腺癌患者的安全性数据, 并且目前尚无共识。润滑剂可能有助于缓解性活动引起的疼痛。癌症治疗后绝经症状的管理可能具有挑战性, 应包括有关导致绝经和可能出现的症状以及可用的治疗方法的信息。然后, 管理人员需要采用整体和多学科的方法以及个性化的护理。

Keywords:

• Menopause
• menopausal symptoms
• cancer
• chemotherapy
• radiation
• endocrine therapy
• non-hormonal therapy
• hormonal therapy
• vasomotor symptoms
• atrophic vaginitis

Potential conflict of interest

No potential conflict of interest was reported by the authors.

Source of funding

Nil.