Managing menopausal symptoms after cancer: an evidence-based approach for primary care
This narrative review provides a summary of the evidence around the treatment of menopause in cancer survivors. Menopausal symptoms often occur at an earlier age in women with cancer and may be more severe than in natural menopause. A meta-analysis of 45 studies of cancer survivors, diagnosed from childhood to 40 years, had a median age of menopause of 44 years. Treatment of cancer-related menopause depends on the type of cancer and the source of menopausal symptoms. Systemic menopausal hormone therapy is the most effective treatment for menopausal symptoms, but it is not suitable for all patients after cancer. It may be used after low-grade, early-stage endometrial cancer, squamous cell cervical cancer and vulvar and vaginal cancers, but it should be avoided after breast cancer and after other oestrogen-dependent gynaecological malignancies. Bone health may also be impaired in post-menopausal women who are cancer survivors, particularly in women with treatment-related menopause or those receiving anti-oestrogen therapies. This review outlines the varied nature of menopause and its treatment in cancer survivors, and primary care physicians need to be aware of the troublesome and ongoing nature of cancer-related menopause. PCPs should discuss this with all patients and consider the most appropriate treatment or referral to a specialist.