Annals of Oncology Advance Access first published online on June 2, 2008
This version published online on June 16, 2008
Annals of Oncology, doi:10.1093/annonc/mdn353
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Practical clinical guidelines for assessing and managing menopausal symptoms after breast cancer
1 School of Women's and Infants Health, King Edward Memorial Hospital, University of Western Australia
2 School of Surgery and Pathology, University of Western Australia, Australia
3 Department of Obstetrics, Gynecology, and Women's Health, Dana-Farber Cancer Institute, Boston, MA
4 Albert Einstein College of Medicine of Yeshiva University, Bronx, NY, USA
5 Department of Psychiatry and Perinatal and Reproductive Psychiatry Clinical Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA
6 Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD, USA
* Correspondence to: Prof. M. Hickey, School of Women's and Infants' Health, The University of Western Australia, 374 Bagot Road, Perth, Western Australia 6008, Tel: +61-8-9340-1328; Fax: +61-8-9381-3031; E-mail: mhickey{at}meddent.uwa.edu.au
Background: The purpose of this study was to provide practical, evidence-based guidelines for evaluating and treating common menopausal symptoms following breast cancer.
Methods: Literature review of the causes, assessment and management of menopausal symptoms in breast cancer patients.
Results: A number of nonhormonal treatments are effective in treating hot flashes. Whether pharmacological treatment is given will depend on the severity of symptoms and on patient wishes. For severe and frequent hot flashes, the best data support the use of venlafaxine, paroxetine and gabapentin in women with breast cancer. Side-effects are relatively common with all these agents. For vaginal dryness, topical estrogen treatment is the most effective but the safety of estrogens following breast cancer is not established. There are limited data on effective treatments for sexual dysfunction during menopause.
Conclusion: Menopausal symptoms after breast cancer should be evaluated and managed as warranted using a systematic approach and may benefit from multidisciplinary input.
atrophic vaginitis, breast cancer, hot flashes, nonhormonal treatment, sexual dysfunction after breast cancer
** Joint senior authors
The fifth and sixth authors are joint senior authors.
Received for publication February 19, 2008. Revision received April 18, 2008. Accepted for publication April 21, 2008.
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