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Menopausal therapy options limited for women with breast cancer

By Bianca Nogrady
Options for managing menopausal symptoms in women with breast cancer are largely limited to lifestyle modifications until new pharmacological agents become available, say the authors of a review.

Writing in the Journal of Clinical Endocrinology and Metabolism, an international group of experts examined the evidence on the management of menopause in women after breast cancer.

Coauthor Professor Susan Davis said women with breast cancer faced challenges in managing their menopausal symptoms because oestrogen therapy, which is the most effective therapy, was contraindicated. 

These women were also often on other treatments to prevent recurrence of their breast cancer, which further affected their hormone levels.

‘They’re not just like other postmenopausal women with low oestrogen, because these therapies completely wipe out any oestrogen,’ said Professor Davis, Program Director of the Women’s Health Research Program at Monash University in Melbourne. ‘These women are profoundly hormone depleted, so they’re often severely symptomatic.’

The authors found that the mainstay of treatment for menopausal women with breast cancer was lifestyle modifications such as smoking cessation, weight loss, limiting or avoiding alcohol, and maintaining adequate vitamin D and calcium levels.

For more severe vasomotor symptoms, they also advocated nonpharmacological therapies such as cognitive behavioural therapy, hypnosis and acupuncture. 

While acknowledging that treatment options for vulvovaginal atrophy were limited, the authors recommended the use of vaginal lubricants and moisturisers.

‘Several emerging approaches such as SERMs [selective estrogen receptor modulators], TSECs [tissue-selective estrogen complex], estetrol and neurokinin B inhibitors show promise as useful agents to expand options for symptom relief with less breast cancer risk but not yet tested in women with prior breast cancer,’ they wrote. 

Professor Davis told Endocrinology Today it was possible to adequately manage bone health and vaginal dryness in most women with breast cancer going through menopause, but hot flushing was still difficult to treat.

‘There are a few drugs under investigation now that could offer women non-hormonal relief in the future, but right now sometimes it’s very challenging, particularly in women taking aromatase inhibitors,’ she said.
J Clin Endocrinol Metab 2017; 102: 3647-3661.

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