Treatment of premature menopause in breast cancer patients

Premature menopause occurs frequently in breast cancer patients (BC), but there are no specific data about its management. Although hormone therapy (HT) is very efficient in relieving menopausal symptoms, the prescription of this type of drug is still not indicated for BC patients, since in one randomized study (of two existing) an increased rate of new breast cancer (BC) occurrence in HT users was reported. The efficacy of other medications, such as serotonin re-uptake inhibitors, clonidine, veralipride, gabapentin, is much lower than that of HT. The efficacy of black cohosh and phyto-oestrogens remains to be proven. The safety of medications other than HT has not been established either in BC patients. There is a need for randomised trials assessing the safety of these drugs. In the meantime, patients should be informed about the absence of safety data. Prevention and treatment of urogenital atrophy is achieved by using vaginal moistures and weak oestrogen topical preparations. Prevention and treatment of osteoporosis is achieved by a healthy life style, adequate calcium and vitamin D intake and if necessary biphosphonate therapy.