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Managing menopausal symptoms after cancer: an evidence-based approach for primary care.
Med J Aust 2018; 208(3):127-132MJ

Abstract

Impaired ovarian function and menopausal symptoms are common after cancer treatment. Menopausal symptoms often occur at an earlier age in women with cancer, and may be more severe than in natural menopause; they may be the most persistent and troubling sequelae of cancer. A third of female patients with cancer report dissatisfaction with the quality and length of physician-patient discussions about reproductive health, including menopause. Systemic menopausal hormone therapy is the most effective treatment for menopausal symptoms, but it is not suitable for all patients after cancer - where it is unsuitable, alternative effective non-hormonal treatments are available. Effective pharmacological agents available to treat vasomotor symptoms include selective serotonin reuptake inhibitors, serotonin-noradrenaline reuptake inhibitors, clonidine and gabapentin. There is increasing evidence supporting cognitive behavioural therapy for the treatment of vasomotor symptoms, in self-help or group settings. Vaginal atrophy can be treated with vaginal (topical) oestrogen with minimal systemic absorption; topical vaginal lubricants may help with vaginal dryness and dyspareunia, with some evidence suggesting that silicone-based products may be more effective than water-based ones. Bone health may be impaired in post-menopausal women with cancer or in cancer survivors, particularly in women with treatment-related menopause or in women receiving anti-oestrogen therapies; this should be managed in addition to menopausal symptoms. Primary care physicians should be aware of the troublesome and ongoing nature of menopausal symptoms after cancer, should discuss them with all patients after cancer treatment, and should consider treatment or referral to a specialist for appropriate management.

Authors+Show Affiliations

Royal Women's Hospital, Melbourne, VIC jennifer.marino@unimelb.edu.au.Royal Women's Hospital, Melbourne, VIC.Royal Women's Hospital, Melbourne, VIC.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

29438648

Citation

Marino, Jennifer L., et al. "Managing Menopausal Symptoms After Cancer: an Evidence-based Approach for Primary Care." The Medical Journal of Australia, vol. 208, no. 3, 2018, pp. 127-132.
Marino JL, McNamara HC, Hickey M. Managing menopausal symptoms after cancer: an evidence-based approach for primary care. Med J Aust. 2018;208(3):127-132.
Marino, J. L., McNamara, H. C., & Hickey, M. (2018). Managing menopausal symptoms after cancer: an evidence-based approach for primary care. The Medical Journal of Australia, 208(3), pp. 127-132.
Marino JL, McNamara HC, Hickey M. Managing Menopausal Symptoms After Cancer: an Evidence-based Approach for Primary Care. Med J Aust. 2018 02 19;208(3):127-132. PubMed PMID: 29438648.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Managing menopausal symptoms after cancer: an evidence-based approach for primary care. AU - Marino,Jennifer L, AU - McNamara,Helen C, AU - Hickey,Martha, PY - 2017/07/17/received PY - 2017/12/08/accepted PY - 2018/2/14/entrez PY - 2018/2/14/pubmed PY - 2019/3/28/medline KW - Cancer KW - Chemotherapy KW - Hormone replacement therapy KW - Menopause KW - Neoplasms, hormone-dependent KW - Radiotherapy KW - Surgical oncology SP - 127 EP - 132 JF - The Medical journal of Australia JO - Med. J. Aust. VL - 208 IS - 3 N2 - Impaired ovarian function and menopausal symptoms are common after cancer treatment. Menopausal symptoms often occur at an earlier age in women with cancer, and may be more severe than in natural menopause; they may be the most persistent and troubling sequelae of cancer. A third of female patients with cancer report dissatisfaction with the quality and length of physician-patient discussions about reproductive health, including menopause. Systemic menopausal hormone therapy is the most effective treatment for menopausal symptoms, but it is not suitable for all patients after cancer - where it is unsuitable, alternative effective non-hormonal treatments are available. Effective pharmacological agents available to treat vasomotor symptoms include selective serotonin reuptake inhibitors, serotonin-noradrenaline reuptake inhibitors, clonidine and gabapentin. There is increasing evidence supporting cognitive behavioural therapy for the treatment of vasomotor symptoms, in self-help or group settings. Vaginal atrophy can be treated with vaginal (topical) oestrogen with minimal systemic absorption; topical vaginal lubricants may help with vaginal dryness and dyspareunia, with some evidence suggesting that silicone-based products may be more effective than water-based ones. Bone health may be impaired in post-menopausal women with cancer or in cancer survivors, particularly in women with treatment-related menopause or in women receiving anti-oestrogen therapies; this should be managed in addition to menopausal symptoms. Primary care physicians should be aware of the troublesome and ongoing nature of menopausal symptoms after cancer, should discuss them with all patients after cancer treatment, and should consider treatment or referral to a specialist for appropriate management. SN - 1326-5377 UR - https://www.unboundmedicine.com/medline/citation/29438648/Managing_menopausal_symptoms_after_cancer:_an_evidence_based_approach_for_primary_care_ L2 - https://www.mja.com.au/doi/10.5694/mja17.00693 DB - PRIME DP - Unbound Medicine ER -