1. Managing Menopausal Symptoms after Breast Cancer Rod Baber

2. 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

3. 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

4. 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

5. 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

6. 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