Management of menopausal symptoms in women with a history of breast cancer

Background

In Australia, the risk of a woman developing breast cancer in her lifetime is 1 in 8. Women who have been treated for breast cancer are five times more likely to experience menopausal symptoms than women without breast cancer. Recurrence of menopausal symptoms in postmenopausal women can follow the cessation of menopause hormone therapy, while the onset of menopausal symptoms can occur naturally in women approaching menopause at the time of diagnosis, or due to treatment-induced menopause (following chemotherapy or ovarian ablation/suppression) or the use of adjuvant endocrine therapy in premenopausal women. A substantial proportion of Australian women diagnosed with breast cancer are diagnosed prior to menopause. In 2012, 35.7% of new cases of breast cancer were diagnosed in Australian women aged 20-54 years. In a study of 578 Australian women with breast cancer who were seeking treatment for menopausal symptoms, 29% reported menopausal symptoms induced by chemotherapy, while 25% reported having menopausal symptoms induced by other treatments such as radiation, endocrine therapy, oophorectomy or hysterectomy.

Menopausal symptoms in women whose symptoms are induced by breast cancer treatment are more severe than in women experiencing “natural” menopause. Management of menopausal symptoms in women with a history of breast cancer is confounded in that systemic menopause hormone therapy, which is efficacious, is generally contraindicated in this patient group, and in particular, women with hormone sensitive disease.

Clinical practice guidelines on the management of breast cancer in younger women and the management of early breast cancer were published previously, and noted that premature menopause is an adverse effect of ovarian ablation. Those guidelines specifically addressed the issue of early menopause and breast cancer, and provided information and strategies for managing and treating menopausal symptoms in younger women with breast cancer. The aim of the current guideline is to provide evidence-based recommendations on the management of menopausal symptoms in all women (regardless of age) who have been treated for breast cancer.