Skip to main content
SpringerLink
Log in

Treatment of Menopausal Symptoms in Breast Cancer Survivors

  • Chapter
  • First Online:
Pre-Menopause, Menopause and Beyond

Part of the book series: ISGE Series ((ISGE))

  • 1274 Accesses

Abstract

Breast cancer is increasing worldwide and affects up to one in eight women who survive up to the age of 85 years in Western countries. Four out of five new cases of breast cancer are diagnosed in women over 50 years, with the peak in the 50–64 years age range. The survival rate of breast cancer patients has significantly increased due to earlier diagnosis and advances in adjuvant treatment: at 5 years after initial diagnosis around 90% of the patients survive in good health conditions. There are now more than 2.5 million breast cancer survivors (BCSs) in the USa. Menopausal symptoms are common among BCSs and can adversely affect Quality of Life and sexual health. Because a wide range of possible treatments is now available for BCSs, menopause after breast cancer should no longer be considered an unsolved problem but an interesting area of further clinical research.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Institutional subscriptions

References

  1. The Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute, 2011

    Google Scholar 

  2. Hickey M (2008) Practical clinical guidelines for assessing and managing menopausal symptoms after breast cancer. Ann Oncol 19(10):1669–1680

    Article  CAS  PubMed  Google Scholar 

  3. Loprinzi CL et al (2008) Symptom management in premenopausal patients with breast cancer. Lancet Oncol 9(10):993–1001

    Article  PubMed  Google Scholar 

  4. Portman DJ, Gass ML, On Behalf of the Vulvovaginal Atrophy Terminology Consensus Conference Panel (2014) Genitourinary syndrome of menopause: new terminology for vulvovaginal atrophy from the International Society for the Study of Women’s Sexual Health and The North American Menopause Society. Maturitas 79(3):349–354

    Article  CAS  PubMed  Google Scholar 

  5. Runowicz CD et al (2016) American Cancer Society/American Society of Clinical Oncology Breast Cancer Survivorship Guidelines. J Clin Oncol 34(6):611–635. doi:10.1200/JCO.2015.64.3809

    Article  CAS  PubMed  Google Scholar 

  6. Biglia N, Cozzarella M, Cacciari F, Ponzone R, Roagna R, Maggiorotto F, Sismondi P (2003) Menopause after breast cancer: a survey on breast cancer survivors. Maturitas 45:29–38

    Article  PubMed  Google Scholar 

  7. The North American Menopause Society (NAMS) (2012) The 2012 hormone therapy. Position statement of the North American Menopause Society Menopause. Menopause 19:257–271

    Article  Google Scholar 

  8. The North American Menopause Society (NAMS) (2013) Management of symptomatic vulvovaginal atrophy: 2013 position statement of the North American Menopause Society. Menopause 20:888–902

    Article  Google Scholar 

  9. Rees M, Pérez-López FR, Ceasu I et al (2012) EMAS clinical guide: low-dose vaginal estrogens for postmenopausal vaginal atrophy. Maturitas 73:171–174

    Article  PubMed  Google Scholar 

  10. The International Menopause Society (IMS) (2013) Updated 2013 International Menopause Society recommendations on menopausal hormone therapy and preventive strategies for midlife health. Climacteric 16:316–337

    Article  Google Scholar 

  11. Holmberg L, Anderson H, HABITS Steering and Data Monitoring Committees (2004) HABITS (hormonal replacement therapy after breast cancer is it safe?), a randomised comparison: trial stopped. Lancet 363:453–455

    Article  CAS  PubMed  Google Scholar 

  12. Von Schoultz E (2005) Menopausal hormone therapy after breast cancer: the Stockholm randomized trial. JNCI 97(7):533–535

    Article  Google Scholar 

  13. Kenemans P, Bundred NJ, Foidart JM et al (2009) Safety and efficacy of tibolone in breast-cancer patients with vasomotor symptoms: a double blind, randomised, noninferiority trial. Lancet Oncol 10:135–146

    Article  CAS  PubMed  Google Scholar 

  14. Holmberg L et al (2008) On behalf of the HABITS study group: increased risk of recurrence after hormone replacement therapy in breast cancer survivors. JNCI 100(7):475–482

    Article  CAS  PubMed  Google Scholar 

  15. Fahlen M et al (2013) Hormone replacement therapy after breast cancer: 10 years follow up of the Stockholm randomized trial. Eur J Cancer 49:52–59

    Article  CAS  PubMed  Google Scholar 

  16. Sismondi P et al (2011) Effects of tibolone on climacteric symptoms and quality of life in breast cancer patients—data from LIBERATE trial. Maturitas 70:365–372

    Article  CAS  PubMed  Google Scholar 

  17. De Villiers TJ, Hall JE, Pinkerton JV, Pérez SC, Rees M, Yang C, Pierroz DD (2016) Revised global consensus statement on menopausal hormone therapy. Maturitas 91:153–155

    Article  PubMed  Google Scholar 

  18. Baber RJ, Panay N, Fenton A (2016) The IMS writing group 2016. IMS recommendations on women midlife health and menopause hormone therapy. Climacteric 19(2):109–150. doi:10.3109/13697137.2015.1129166

    Article  CAS  PubMed  Google Scholar 

  19. Rada G, Capurro D, Pantoja T, Corbalán J, Moreno G, Letelier LM, Vera C (2010) Non-hormonal interventions for hot flushes in women with a history of breast cancer. Cochrane Database Syst Rev (9). doi:10.1002/14651858.CD004923.pub2

  20. Handley A, Williams M (2015) The efficacy and tolerability of SSRI/SNRIs in the treatment of vasomotor symptoms in menopausal women: a systematic review. J Am Assoc Nurse Pract 27(1):54–61

    PubMed  Google Scholar 

  21. Biglia N et al (2005) Evaluation of low-dose venlafaxine hydrochloride for the therapy of hot flushes in breast cancer survivors. Maturitas 52(1):78–85

    Article  CAS  PubMed  Google Scholar 

  22. Biglia N, Kubatzki F, Sgandurra P, Ponzone R, Marenco D, Peano E, Sismondi P (2007) Mirtazapine for the treatment of hot flushes in breast cancer survivors: a prospective pilot trial. Breast J 13(5):490–495

    Article  CAS  PubMed  Google Scholar 

  23. Biglia N, Bounous VE, Susini T, Pecchio S, Sgro LG, Tuninetti V, Torta R (2016) Duloxetine and escitalopram for hot flushes: efficacy and compliance in breast cancer survivors. Eur J Cancer Care. doi:10.1111/ecc.12484

  24. Carroll DG, Kelley KW (2009) Use of antidepressants for Management of Hot Flashes. Pharmacotherapy 29:1357–1374

    Article  CAS  PubMed  Google Scholar 

  25. Orleans RJ, Li L, Kim MJ, Guo J, Sobhan M, Soule L, Joffe HV (2014) FDA approval of paroxetine for menopausal hot flushes. N Engl J Med 370:1777–1779

    Article  CAS  PubMed  Google Scholar 

  26. Biglia N, Sgandurra P, Peano E, Marenco D, Moggio G, Bounous V, Tomasi Cont N, Ponzone R, Sismondi P (2009) Non-hormonal treatment of hot flushes in breast cancer survivors: gabapentin vs. vitamin E. Climacteric 12(4):310–318

    Article  CAS  PubMed  Google Scholar 

  27. Morrow PK, Mattair DN, Hortobagyi GN (2011) Hot flashes: a review of pathophysiology and treatment modalities. Oncologist 16(11):1658–1656

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Lethaby A, Marjoribanks J, Kronenberg F, Roberts H, Eden J, Brown J (2013) Phytoestrogens for menopausal vasomotor symptoms. Cochrane Database Syst Rev 10(12):CD001395

    Google Scholar 

  29. Du M, Yang X, Hartman JA, Cooke PS, Doerge DR, Ju YH, Helferich WG (2012) Low- dose dietary genistein negates the therapeutic effect of tamoxifen in athymic nude mice. Carcinogenesis 33(4):895–901

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Van Duursen MB, Nijmeijer SM, de Morree ES, de Jong PC, van den Berg M (2011) Genistein induces breast cancer-associated aromatase and stimulates estrogen-dependent tumor cell growth in in vitro breast cancer model. Toxicology 289(2–3):67–73

    Article  PubMed  Google Scholar 

  31. Leach MJ, Moore V. Black cohosh (Cimicifuga spp.) for menopausal symptoms. Cochrane Database Syst Rev. 2012 Sep 12;(9):CD007244

    Google Scholar 

  32. Carson JW, Carson KM, Porter LS, Keefe FJ, Seewaldt VL (2009) Yoga of awareness program for menopausal symptoms in breast cancer survivors: results from a randomized trial. Support Care Cancer 17:1301–1309

    Article  PubMed  Google Scholar 

  33. Walker EM et al (2010) Acupuncture versus venlafaxine for the management of vasomotor symptoms in patients with hormone receptor-positive breast cancer: a randomized controlled trial. J Clin Oncol 28:634–640

    Article  CAS  PubMed  Google Scholar 

  34. Venzke L, Calvert JF, Gilbertson B (2010) A randomized trial of acupuncture for vasomotor symptoms in post-menopausal women. Complement Ther Med 18:59–66

    Article  PubMed  Google Scholar 

  35. Lipov EG, Joshi JR, Lipov S, Sanders SE, Siroko MK (2008) Cervical sympathetic blockade in a patient with post-traumatic stress disorder: a case report. Ann Clin Psychiatry 20:227–228

    Article  PubMed  Google Scholar 

  36. Crandall C, Petersen L, Ganz PA et al (2004) Association of breast cancer and its therapy with menopause-related symptoms. Menopause 11:519–530

    Article  PubMed  Google Scholar 

  37. Baumgart J, Nilsson K, Stavreus-Evers A, Kask K, Villman K, Lindman H et al (2011) Urogenital disorders in women with adjuvant endocrine therapy after early breast cancer. Am J Obstet Gynecol 204(1):26.e 1-7

    Google Scholar 

  38. Baumgart J, Nilsson K, Evers AS, Kallak TK, Poromaa IS (2013) Sexual dysfunction in women on adjuvant endocrine therapy after breast cancer. Menopause 20(2):162–168

    Google Scholar 

  39. Nappi RE, Kokot-Kierepa M (2012) Vaginal health: insights, views and amp; attitudes (VIVA) – results from an international survey. Climacteric 15:36–44

    Article  CAS  PubMed  Google Scholar 

  40. Újhelyi M et al (2016) A European Society of Breast Cancer Specialists (EUSOMA). Orv Hetil 157:1674–1682

    Article  PubMed  Google Scholar 

  41. Biglia N et al (2015) Genitourinary syndrome of menopause in breast cancer survivors: are we facing new and safe hopes? Clin Breast Cancer 15:413–420. doi:10.1016/j.clbc.2015.06.005

    Article  PubMed  Google Scholar 

  42. Dew JE, Wren BG, Eden JA (2003) A cohort study of topical vaginal estrogen therapy in women previously treated for breast cancer. Climacteric 6:45–52

    Article  CAS  PubMed  Google Scholar 

  43. Kendall A, Dowsett M, Folkerd E, Smith I (2006) Caution: vaginal estradiol appears to be contraindicated in postmenopausal women on adjuvant aromatase inhibitors. Ann Oncol Off J Eur Soc Med Oncol 17:584–587

    Article  CAS  Google Scholar 

  44. Wills S et al (2012) Effects of vaginal estrogens on serum estradiol levels in postmenopausal breast cancer survivors and women at risk of breast cancer taking an aromatase inhibitor or a selective estrogen receptor modulator. J Oncol Pract 8:144–148

    Article  PubMed  PubMed Central  Google Scholar 

  45. American College of Obstetricians and Gynecologists’ Committee on Gynecologic Practice, Farrell R (2016) ACOG Committee opinion no. 659: the use of vaginal estrogen in women with a history of estrogen-dependent breast cancer. Obstet Gynecol 127(3):e93–e96. doi:10.1097/AOG.0000000000001351

    Article  Google Scholar 

  46. Salvatore S, Nappi RE, Zerbinati N et al (2014) A 12 week treatment with fractional CO2 laser for vulvovaginal atrophy: a pilot study. Climateric 17:363–369

    Article  CAS  Google Scholar 

  47. Gambacciani M, Levancini M, Cervigni M (2015) Vaginal erbium laser: the second-generation thermotherapy for the genitourinary syndrome of menopause. Climateric 18:757–763

    Article  CAS  Google Scholar 

  48. Burich RA, Mehta NR, Wurz GT, McCall JL, Greenberg BE, Bell KE, Griffey SM, DeGregorio MW (2012) Ospemifene and 4-hydroxyospemifene effectively prevent and treat breast cancer in the MTag.Tg transgenic mouse model. J Am Menopause Soc 19:96–103

    Article  Google Scholar 

  49. Bachmann GA, Komi JO, Ospemifene Study Group (2010) Ospemifene effectively treats vulvovaginal atrophy in postmenopausal women: results from a pivotal phase 3 study. Menopause 17:480–486

    PubMed  Google Scholar 

  50. Simon J, Lin V, Radovich C, Bachmann GA, The Ospemifene Study Group (2012) One year long-term safety extension study of ospemifene for the treatment of vulvar and vaginal atrophy in postmenopausal women with a uterus. Menopause 20:418–427

    Google Scholar 

  51. Portman DJ, Bachmann GA, Simon JA, Ospemifene Study Group (2013) Ospemifene, a novel selective estrogen receptor modulator for treating dyspareunia associated with postmenopausal vulvar and vaginal atrophy. Menopause 20:623–630

    Article  PubMed  Google Scholar 

  52. Goldstein SR, Bachmann GA, Koninckx PR et al (2014) Ospemifene 12-month safety and efficacy in postmenopausal women with vulvar and vaginal atrophy. Climacteric 17:173–182

    Article  CAS  PubMed  Google Scholar 

  53. Cuzick J et al (2013) Selective oestrogen receptor modulators in prevention of breast cancer: an updated meta-analysis of individual participant data. Lancet 381:1827–1834

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynaecology, University of Turin, “Umberto I Hospital”, Turin, Italy

    Piero Sismondi, Valentina Elisabetta Bounous, Valentina Tuninetti, Viola Liberale, Martina Gallo & Nicoletta Biglia

Authors
  1. Piero Sismondi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Valentina Elisabetta Bounous
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Valentina Tuninetti
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Viola Liberale
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Martina Gallo
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Nicoletta Biglia
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Piero Sismondi .

Editor information

Editors and Affiliations

  1. Professor emeritus for Gynaecological Endocrinology and Reproductive Medicine, University of Bern, Bern, Switzerland

    Martin Birkhaeuser

  2. International Society of Gynecological Endocrinology, Pisa, Italy

    Andrea R. Genazzani

Rights and permissions

Reprints and permissions

Copyright information

© 2018 International Society of Gynecological Endocrinology

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Sismondi, P., Bounous, V.E., Tuninetti, V., Liberale, V., Gallo, M., Biglia, N. (2018). Treatment of Menopausal Symptoms in Breast Cancer Survivors. In: Birkhaeuser, M., Genazzani, A. (eds) Pre-Menopause, Menopause and Beyond. ISGE Series. Springer, Cham. https://doi.org/10.1007/978-3-319-63540-8_19

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-63540-8_19

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-63539-2

  • Online ISBN: 978-3-319-63540-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation