The management of menopausal sequelae in patients with breast cancer

The use of chemotherapy and tamoxifen for young women with breast cancer results in premature menopause in a significant number of patients. Early menopause has serious vasomotor, psychological, genitourinary, cardiac and skeletal effects. Psychopharmacological and herbal preparations are widely used for the treatment of vasomotor symptoms. The incidence of psychological and depressive illness following the menopause in women with breast cancer is significantly higher than seen with the natural menopause. Targeting this population of patients for early diagnosis and psychiatric intervention is recommended. Local vaginal moisturising or oestrogen cream would help to alleviate some of the urogenital symptoms. Patients whose treatment included Anthracycline chemotherapy or radiation to the heart and those with a history of heart disease, should be monitored closely for latecardiac complications. Early menopause is the major risk factor for the development of osteoporosis. Weight bearing exercise, bisphosphonate or calcitonin therapy are all useful in treating osteoporosis. Should a woman with a history of breast cancer be given hormone replacement therapy is one of the most controversial issues in the oncology field. There are no published prospective randomised studies on the subject. The available data suggests an increase of 5% of breast cancer related events when hormone replacement therapy is given to women with breast cancer. However, in certain situations, this could be given after a detailed explanation and documentation. The patient and physician should balance the severity of symptoms against the increased breast cancer related events and the final decision should be left to the patient.