title: Genitourinary Syndrome of Menopause in Breast Cancer Survivors: Are We Facing New and Safe Hopes?
abstract: Breast cancer survivors (BCSs) often suffer from menopausal symptoms induced by systemic treatments, with a consequent negative effect on quality of life. Since the introduction of aromatase inhibitors as the standard therapy for hormone-dependent tumors, genitourinary syndrome of menopause (GSM) has become a main problem for BCSs. This new terminology refers to the wide range of vaginal and urinary symptoms related to menopause, which can be relieved by estrogen therapy. Unfortunately, systemic hormone therapy is contraindicated for BCSs and also vaginal estrogens at standard dosage might influence the risk of recurrence because they cause a significant increase of circulating estrogens. Nonhormonal vaginal moisturizers or lubricants are the first choice for BCSs but only have limited and short-term efficacy. New strategies of management of GSM are now available, including: (1) low-dose or ultra low-dose vaginal estrogens; (2) oral selective estrogen receptor modulators (ospemifene); (3) androgen therapy; (4) physical treatment with vaginal laser; and (5) psychosocial interventions. In this review we discuss and analyze these different options.
authors.affiliation: Department of Obstetrics and Gynaecology, Umberto I Hospital, University of Turin, Turin, Italy. Electronic address: nicoletta.biglia@unito.it.
authors.forename: Nicoletta
authors.initials: N
authors.lastname: Biglia
authors.affiliation: Department of Obstetrics and Gynaecology, Umberto I Hospital, University of Turin, Turin, Italy.
authors.forename: Valentina E
authors.initials: VE
authors.lastname: Bounous
authors.affiliation: Department of Obstetrics and Gynaecology, Umberto I Hospital, University of Turin, Turin, Italy.
authors.forename: Luca G
authors.initials: LG
authors.lastname: Sgro
authors.affiliation: Department of Obstetrics and Gynaecology, Umberto I Hospital, University of Turin, Turin, Italy.
authors.forename: Marta
authors.initials: M
authors.lastname: D'Alonzo
authors.affiliation: Department of Obstetrics and Gynaecology, Umberto I Hospital, University of Turin, Turin, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Pecchio
authors.affiliation: Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, Research Center of Reproductive Medicine, Unit of Gynecological Endocrinology and Menopause, IRCCS S. Matteo Foundation, University of Pavia, Pavia, Italy.
authors.forename: Rossella E
authors.initials: RE
authors.lastname: Nappi
mesh_terms: D018931:Antineoplastic Agents, Hormonal / Q000009:adverse effects*; D001943:Breast Neoplasms / Q000188:drug therapy*; D005260:Female; D052776:Female Urogenital Diseases / Q000139:chemically induced*; D006801:Humans; D008593:Menopause / Q000187:drug effects*; D017741:Survivors; D013577:Syndrome
chemical_list: D018931:Antineoplastic Agents, Hormonal
keywords: BCS; GSM; Iatrogenic menopause; Treatment; Vulvovaginal atrophy (VVA)