Managing Menopausal Symptoms after Breast Cancer Rod Baber

What are menopausal symptoms ? Vasomotor symptoms: hot flushes night sweats Vulvo-vaginal dryness Sleep disturbance Mood disturbance Sexual dysfunction NIH State-of-the-Science Panel. Ann Intern Med 2005

Why do breast cancer patients get menopausal symptoms? Around 60% affected Young women with chemotherapy-induced ovarian failure Young women undergoing oophorectomy Peri and postmenopausal women who stop HRT on diagnosis of breast cancer Pre and postmenopausal women taking endocrine therapy (for up to 10 years) Hot flushes are more frequent and severe than in spontaneous menopause Anti-estrogen therapies may exacerbate symptoms: Vaginal dryness particularly severe with aromatase inhibitors Hickey et al 2008, Kemp et al 2014, Marino et al 2014, Howell et al 2005, ACOG 2014

Why are menopausal symptoms after breast cancer problematic? They may impair quality of life: Worse than the cancer treatment for some women May impact on tolerance of endocrine therapy Up to 40% discontinue because of hot flushes May add to common post-cancer problems such as sleep disturbance and fatigue May have implications for prognosis Risks of early menopause may contribute to morbidity and mortality Osteoporosis and cardiovascular disease Howard-Anderson et al 2012, Chen et al 2013

How long do hot flushes last ? Most severe symptoms around the LMP Mean duration of vasomotor symptoms at natural menopause is 8-10 years Duration after surgical or chemo-induced menopause unknown Politi et al 2008, Col et al 2008, Freeman et al 2014

How can symptoms be managed? Most women have several symptoms Vasomotor symptom are the most common reason to seek treatment, but additive effect of symptoms is unknown Estrogen is the most effective treatment for VMS (85% reduction) and also improves Vulvo-vaginal dryness Potentially mood and sleep Bone health MacLennan et al 2006, Suckling et al 2006, Soares and Frey 2010, Formoso et al 2012