Cancer treatment induced menopause can be managed in several evidence based ways

Research from general practitioner Mariken Stegmann together with a group of international researchers shows that menopausal hormonal therapy (MHT) doesn’t need to be strictly avoided after all types of cancer. On the other hand, the researchers also showed that for several other therapies ample evidence exists. They investigated this performing an extensive search and summary of the literature. The results were published in the Lancet this week. 

Photo by: Margot Scheerder

MHT is often thought to be contraindicated for patients with a present or history of cancer. ‘Indeed for breast cancer, especially oestrogen receptor positive, there is evidence of moderate level to better avoid MHT. For uterine sarcomas and serous and granulosa cell ovarian cancer the same advice is given, although the level of evidence is low. However, for other types of cancer such as endometrial cancer, epithelial ovarian cancer and lung cancer the evidence suggests MHT can be given without problems’, says Stegmann. 

Non-hormonal therapy 

Vasomotor symptoms can also be treated with non-pharmacological or non-hormonal therapies. For selected SSRI’s and SNRI’s, specific anticonvulsants, oxybiutynin, clonidine, cognitive behavioural therapy and hypnosis, are likely to be effective. Stellate ganglion block, acupuncture and yoga and mindfullnessbased stress reduction are possibly effective. For sexual dysfunction less therapy options are likely to reduce symptoms, but vaginal lubricants or moisturisers can be effective.

Multidisciplinary approach

The researchers emphasise a multidisciplinary approach including primary care, and if appropriate allied health care providers, is needed to empower patients to make shared evidence-based and individualized treatment decisions.

Menopause after cancer

More than 9 million women are diagnosed with cancer each year and treatments commonly induce early menopause and menopausal symptoms for example in patients with breast cancer, gynecological cancers, hematological cancers or low colorectal cancers. The researchers also summarize the possibilities for preservation of ovarian function before cancer treatment and discuss there are no consensus criteria for diagnosing menopause after cancer. The article is part of a series on menopause also containing articles about an empowerment model for managing menopause, optimising health after early menopause and promoting good mental health over the menopause transition.

Read the full publication in The Lancet.