title: Management of menopausal symptoms in breast cancer patients.
abstract: In breast cancer patients, menopausal symptoms such as hot flashes, urogenital problems, musculoskeletal symptoms and cognitive dysfunction are common, regardless of age at diagnosis. They affect quality of life and systemic therapy will worsen this. Endocrine and/or chemotherapy may induce temporary or permanent ovarian failure and can exacerbate these symptoms. Hormone therapy (HT) has been studied in breast cancer survivors, but safety has been questioned. The HABITS trial investigating estrogen-based HT, as well as the LIBERATE trial investigating tibolone, found a reduction in disease-free survival for those treated. Alternative strategies are needed, as menopause symptoms may reduce compliance with breast cancer treatments. This article reviews recently published strategies to tackle menopausal problems in breast cancer patients. Antidepressants may help with hot flashes. Acupuncture and hypnosis can also be used but the evidence is conflicting. For urogenital problems vaginal moisturizers or topical estrogens can be employed. A musculoskeletal syndrome induced by aromatase inhibitors (AIs) is frequently encountered and currently there are no effective treatment strategies. Bisphosphonates reduce AI-induced bone resorption and can also increase disease-free and overall survival. Standard-dose endocrine and chemotherapy are associated with a decline in cognitive function.
authors.affiliation: German Breast Group, GBG Forschungs GmbH, Neu-Isenburg, Germany. Sibylle.loibl@germanbreastgroup.de
authors.forename: S
authors.initials: S
authors.lastname: Loibl
authors.forename: A
authors.initials: A
authors.lastname: Lintermans
authors.forename: A S
authors.initials: AS
authors.lastname: Dieudonné
authors.forename: P
authors.initials: P
authors.lastname: Neven
mesh_terms: D000928:Antidepressive Agents / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000009:adverse effects*; D001943:Breast Neoplasms / Q000150:complications*; D003072:Cognition Disorders / Q000188:drug therapy* / Q000209:etiology; D000529:Complementary Therapies; D004164:Diphosphonates / Q000627:therapeutic use; D015914:Estrogen Replacement Therapy / Q000009:adverse effects; D004967:Estrogens / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D052776:Female Urogenital Diseases / Q000188:drug therapy* / Q000209:etiology; D019584:Hot Flashes / Q000188:drug therapy* / Q000209:etiology / Q000628:therapy; D006801:Humans; D008593:Menopause; D009140:Musculoskeletal Diseases / Q000188:drug therapy* / Q000209:etiology
chemical_list: D000928:Antidepressive Agents; D000970:Antineoplastic Agents; D004164:Diphosphonates; D004967:Estrogens