Managing menopause after cancer.

Globally, 9 million women are diagnosed with cancer each year. Breast cancer is the most commonly diagnosed cancer worldwide, followed by colorectal cancer in high-income countries and cervical cancer in low-income countries. Survival from cancer is improving and more women are experiencing long-term effects of cancer treatment, such as premature ovarian insufficiency or early menopause. Managing menopausal symptoms after cancer can be challenging, and more severe than at natural menopause. Menopausal symptoms can extend beyond hot flushes and night sweats (vasomotor symptoms). Treatment-induced symptoms might include sexual dysfunction and impairment of sleep, mood, and quality of life. In the long term, premature ovarian insufficiency might increase the risk of chronic conditions such as osteoporosis and cardiovascular disease. Diagnosing menopause after cancer can be challenging as menopausal symptoms can overlap with other common symptoms in patients with cancer, such as fatigue and sexual dysfunction. Menopausal hormone therapy is an effective treatment for vasomotor symptoms and seems to be safe for many patients with cancer. When hormone therapy is contraindicated or avoided, emerging evidence supports the efficacy of non-pharmacological and non-hormonal treatments, although most evidence is based on women older than 50 years with breast cancer. Vaginal oestrogen seems safe for most patients with genitourinary symptoms, but there are few non-hormonal options. Many patients have inadequate centralised care for managing menopausal symptoms after cancer treatment, and more information is needed about cost-effective and patient-focused models of care for this growing population.

Informations de copyright

Copyright © 2024 Elsevier Ltd. All rights reserved.

Déclaration de conflit d'intérêts

Declaration of interests MH declares salary funding from the Australian National Health and Medical Research Council, support for meeting attendance from the UK National Institute for Health and Care Excellence, and the following roles: principal investigator for a clinical trial of salpingectomy vs salpingo-oophorectomy for prevention of ovarian cancer (TUBA-WISP II); board member for Breastscreen Victoria; editor for the Cochrane Collaboration; recipient of a fellowship from the Lundbeck Foundation (2022-23); site investigator for a clinical trial of a non-hormonal agent (Q-122) for vasomotor symptoms in patients with breast cancer (QUE Oncology, 2020-22); and site investigator for a clinical trial of a medical device for treating vaginal dryness (Madorra). JS is a site investigator for neurokinin B antagonist for vasomotor symptoms and has received travel grants for conference attendance from Mylan and Besins. AHP has received royalties for coauthorship of the breast cancer survivorship section of UpToDate. DJB acknowledges financial support from Precision Oncology Ireland, which is part-funded by the Science Foundation Ireland Strategic Partnership Programme (grant number 18/SPP/3522), and has received co-funding from AstraZeneca. DJB is the principal investigator of an investigator-initiated clinical trial of digital cognitive behavioural therapy and gabapentin for treatment of menopause symptoms after cancer, supported by the Irish Cancer Society (WHIBREN2020). DJB has received speaker fees or honoraria from Bayer, GSK, MSD, Olympus, and AstraZeneca and has participated on a data safety monitoring board or advisory board for Astellas, Bayer, and GSK. All other authors declare no competing interests.