Both pre-menopausal and post-menopausal women with breast cancer frequently experience menopausal symptoms induced by their breast cancer treatment. These menopausal symptoms are often more severe than “natural” menopause. The aim of the current guideline is to provide evidence-based recommendations for a range of interventions for the management of menopausal symptoms in women who have been treated for breast cancer.
A multidisciplinary Working Group was established including medical oncologists. The body of evidence identified to inform the recommendations includes randomised controlled trials (RCTs) in women with a history of breast cancer, and published systematic reviews and specific RCTs (MS-FLASH) in a general menopausal population. Efficacy outcomes of interest were improvement in vasomotor symptoms (hot flushes, night sweats), sleep disturbance, vulvovaginal symptoms and sexual function, psychological wellbeing, and quality of life. Safety outcomes of interest included the incidence of breast cancer recurrence.
Practice Points and graded Recommendations have been developed regarding the use of specific complementary therapies, pharmacological therapies and hormonal therapies for vasomotor symptoms, sleep disturbance, and vulvovaginal symptoms and sexual function. There was insufficient evidence to develop recommendations for the remaining symptoms.
These Guidelines propose a step-wise approach to management based on the relative safety (and then efficacy) of the different classes of treatment and the particular symptoms experienced by an individual woman. Accordingly, the first Recommendations are those for complementary therapies, followed by Recommendations for pharmacological therapies. Recommendations regarding the use of hormone therapies are presented last, as hormone therapies should only be considered for severe, unresponsive symptoms and after discussion with an oncologist. Further research is needed to address the effectiveness and safety of specific treatments in women who have been treated for breast cancer.