Dr Stella Milsom
Department of Reproductive Medicine at National Women’s Hospital
In general, hormone therapy (MHT) is first line pharmacological management for women with significant menopausal symptoms. There are relatively few contraindications to MHT when compared with synthetic hormones. However, the use of MHT is strongly discouraged by the majority of professional organisations in breast cancer survivors.
Survival rates after breast cancer with modern therapy now exceed 85%. This is reflected by an increasing number of women with a breast cancer history presenting to primary care for management of menopausal symptoms. These are often severe and debilitating, regardless of whether the aetiology of menopause is spontaneous, induced by therapies used to treat breast cancer, or in association with adjuvant endocrine therapies (AET). These women may have a significantly reduced quality of life and management needs to be effective and individualised.
While the pathway to resolution of menopausal symptoms is not as straightforward as in a woman without a history of breast cancer, and the use of AET may complicate decision making, there are a number of current and emerging evidence based non hormone options that potentially will alleviate symptoms.
These will be discussed and their efficacy reviewed, along with situations where MHT may still be considered.