Guidance for managing menopausal symptoms in survivors of breast cancer

Lifestyle modifications and treatment individualization are the focus of new guidelines that detail the management of menopausal symptoms in breast cancer survivors, according to recommendations from a recent review published in theJournal of Clinical Endocrinology & Metabolism.

“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, MD, 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.”

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

Based on this review, they made the following recommendations:

• For all women with a history of previous breast cancer, smoking cessation, weight loss if necessary, limit/avoid alcohol, maintain adequate vitamin D and calcium levels, maintain a healthy diet, and regular physical activity are stressed.
• Helpful non-pharmacologic therapies for vasomotor symptoms (VMS) can include cognitive behavioral therapy, hypnosis, and acupuncture, vaginal lubricants, and moisturizers.
• Other options for symptom relief that carry less breast cancer risk, but which have not yet been confirmed as safe in women with previous breast cancer may include tissue selective estrogen complex (TSECs), estetrol, and neurokinin B inhibitors.