Menopause Management in Patients With Cancer

Area of Science:

• Oncology
• Gynecology
• Menopause Management

Background:

• Menopausal symptoms are prevalent and severe in cancer patients, especially those with treatment-induced menopause.
• Management necessitates balancing symptom relief with oncologic safety, requiring careful consideration of cancer type and hormone sensitivity.

Purpose of the Study:

• To provide a practical, symptom-based framework for managing menopause in cancer patients.
• To emphasize risk stratification and collaboration between gynecologists and oncologists for individualized care.

Main Methods:

• Synthesized current evidence and guideline recommendations from various study types and society statements.
• Organized findings by symptom domain and stratified by cancer type and hormone sensitivity.

Main Results:

• Nonhormonal therapies (SSRIs, gabapentin, lifestyle changes) are first-line for vasomotor symptoms across cancer types.
• Vaginal estrogen is effective for genitourinary syndrome of menopause and may be considered in select breast cancer survivors.
• Systemic hormone therapy is contraindicated in hormone receptor-positive breast cancer but may be considered in select non-hormone-dependent malignancies.

Conclusions:

• A symptom-based, risk-stratified approach, in collaboration with oncology, enables safe and effective menopause management in cancer patients.
• Careful consideration of nonhormonal factors (thrombotic risk, hepatic function, drug interactions, cardiometabolic health) is crucial for safe management.
• This approach supports individualized care and improves the quality of life for cancer patients experiencing menopausal symptoms.