Menopausal symptoms in breast cancer survivors: management update.

British Journal of General Practice, January 2013 51 MENOPAUSE IN BREAST CANCER SURVIVORS The increasing incidence of breast cancer combined with improving survival means that women live with the effects of cancer and its treatment for many years. Menopausal symptoms are a significant issue in breast cancer survivors for several reasons. Women taking hormone replacement therapy (HRT) at the time of diagnosis are advised to cease treatment. The majority of breast cancers are oestrogen receptor (ER)-positive, so treatments to block the effects of oestrogen (such as oral endocrine therapy and ovarian suppression/ablation treatments) form an important part of management. In addition, premenopausal women frequently experience an early menopause as a result of chemotherapy. Menopausal symptoms in this setting are similar in nature to those experienced at natural menopause, and can include; hot flushes, night sweats, vaginal symptoms, emotional upset, musculoskeletal symptoms, and sexual dysfunction. However, they may be more abrupt in onset and more persistent. Aromatase inhibitors have the additional side effects of osteoporosis and arthralgia, and a switch to tamoxifen may produce better tolerance. Genetic predispositions to severe symptoms are a focus of current research. As well as affecting quality of life, these issues can compromise adherence to endocrine therapies, thus putting patients whose side effects are poorly managed at increased risk of recurrence. Menopausal symptoms can adversely impact on selfesteem, body image, and sexual function.1 Anxiety and depression can contribute to these issues and should be managed as in other women.