Treatment

New Guidelines for Treating Estrogen Depletion Symptoms Following Breast Cancer

The Endocrine Society has released several recommendations and statements to guide the treatment of symptoms associated with estrogen depletion among survivors of breast cancer, based on a review of existing data.

The estimated 9 million breast cancer survivors worldwide often face a number of symptoms associated with estrogen depletion, such as sleep disorders, vulvovaginal atrophy (VVA), vasomotor symptoms (VMS), mood changes, depressive symptoms, cardiovascular disease, osteopenia, and osteoporosis.

To treat symptoms associated with estrogen depletion, the recommendations include:

  • Women should optimize lifestyle following breast cancer survival rather than receive menopausal hormone therapy or tibolone.
  • Women with moderate to severe symptoms of estrogen depletion may benefit from mind-brain-behavior therapy or non-hormone pharmacologic therapies.
  • Women with VMS can benefit from selective serotonin /noradrenaline reuptake inhibitors and gabapentenoid agents.
  • Various non-hormonal agents are available for women with osteoporosis.
  • Treatment of VVA is an area of need that remains unmet.
  • Low-dose vaginal estrogen is not generally advised for women who have survived breast cancer, especially those on aromatase inhibitors. Although it is absorbed in small amounts with blood levels, it could potentially stimulate occult breast cancer cells.
  • Although intravaginal dehydroepiandrosterone  and oral ospemiphene have been approved to treat dyspareunia associated with VVA, little is known about the safety of use following breast cancer.
  • Although vaginal laser therapy is utilized for VVA, the evidence of its efficacy from sham-controlled studies is still lacking.
  • Therapies currently being developed for potential use in the future include lasofoxifene, neurokinin B inhibitors, stellate ganglion blockade, vaginal testosterone, and estetrol.

“A variety of non-hormone options and therapies are available for treatment of estrogen-depletion symptoms and clinical problems after a diagnosis of breast cancer,” the reviewers concluded. “Individualization of treatment is essential.”

—Christina Vogt

Reference:

Santen RJ, Stuenkel CA, Davis SR, Pinkerton JV, Gompel A, Lumsden MA. Managing menopausal symptoms and associated clinical issues in breast cancer survivors [Published online August 2, 2017]. J Clin Endocrinol Metab. doi:10.1210/jc.2017-01138.