Menopause Management in Patients With Cancer

This Narrative Review provides a practical, symptom-based framework for the management of menopause in patients with cancer, emphasizing risk stratification and collaboration with oncology. Current evidence and guideline recommendations were synthesized from randomized trials, observational studies, systematic reviews, and major society position statements, with findings organized by symptom domain and stratified by cancer type and hormone sensitivity to support clinical decision making. Menopausal symptoms are common and often severe in patients undergoing cancer treatment, particularly in those with treatment-induced menopause, and management requires balancing symptom relief with oncologic safety. Nonhormonal therapies are first-line treatment across cancer types, with strong evidence supporting selective serotonin and norepinephrine reuptake inhibitors, gabapentin, and lifestyle interventions for vasomotor symptoms. Vaginal estrogen is effective for genitourinary syndrome of menopause, is appropriate in most gynecologic cancers, and may be considered in select breast cancer survivors after shared decision making. Systemic hormone therapy remains contraindicated in hormone receptor-positive breast cancer but may be considered in carefully selected patients with non-hormone-dependent malignancies or low-risk gynecologic cancers. Nonhormonal considerations-including thrombotic risk, hepatic function, drug-drug interactions, and cardiometabolic health-are critical to safe management. A symptom-based, risk-stratified approach enables gynecologists to manage menopause in patients with cancer through collaboration with oncology, supporting individualized care and improved quality of life.