The joint burden of
cancer and menopause impacts millions of women globally. This review provides an approach to management of menopausal symptoms after
cancer in all settings. This includes an overview of current evidence for both hormonal and non-hormonal treatments for vasomotor symptoms and vaginal dryness after
cancer. Systemic menopausal
hormone therapy provides symptom control and may be used after most
cancers but should be avoided after
estrogen receptor-positive
breast cancer and after some other
estrogen-dependent
cancers. Non-hormonal
therapies have been minimally studied in women after a
cancer diagnosis and, where they have been studied, it is usually in women with
breast cancer. Non-hormonal methods to manage vasomotor symptoms include cognitive behavioral therapy,
hypnosis,
selective serotonin reuptake inhibitors,
serotonin noradrenaline reuptake inhibitors,
clonidine, and
gabapentin. Vaginal
estrogen may be useful to address vaginal dryness. However, safety data in
breast cancer patients are still lacking and there is currently no consensus.
Lubricants may also help with
pain with sexual activity. Management of menopausal symptoms after
cancer may be challenging and should include information about induced menopause and possible symptoms as well as available treatments. Management then requires a holistic and multidisciplinary approach with individualized care.