Affiliations 

  • 1 Department of Obstetrics, Gynaecology and Newborn Health, University of Melbourne and the Royal Women's Hospital, Melbourne, VIC, Australia. Electronic address: hickeym@unimelb.edu.au
  • 2 Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, WHO, Lyon, France
  • 3 Department of Obstetrics and Gynaecology, School of Gynaecology, University of Glasgow, Glasgow, UK
  • 4 Department of Primary and Long-term Care, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
  • 5 International Agency for Research on Cancer, WHO, Lyon, France
  • 6 Teal Sisters, Lusaka, Zambia
  • 7 Department of Surgery, University of Malaya, Kuala Lumpur, Malaysia
  • 8 Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
  • 9 Gynaecological Oncology Group, UCD School of Medicine, Mater Misericordiae University Hospital, Dublin, Ireland; Systems Biology Ireland, UCD School of Medicine, Dublin, Ireland
Lancet, 2024 Mar 09;403(10430):984-996.
PMID: 38458217 DOI: 10.1016/S0140-6736(23)02802-7

Abstract

Globally, 9 million women are diagnosed with cancer each year. Breast cancer is the most commonly diagnosed cancer worldwide, followed by colorectal cancer in high-income countries and cervical cancer in low-income countries. Survival from cancer is improving and more women are experiencing long-term effects of cancer treatment, such as premature ovarian insufficiency or early menopause. Managing menopausal symptoms after cancer can be challenging, and more severe than at natural menopause. Menopausal symptoms can extend beyond hot flushes and night sweats (vasomotor symptoms). Treatment-induced symptoms might include sexual dysfunction and impairment of sleep, mood, and quality of life. In the long term, premature ovarian insufficiency might increase the risk of chronic conditions such as osteoporosis and cardiovascular disease. Diagnosing menopause after cancer can be challenging as menopausal symptoms can overlap with other common symptoms in patients with cancer, such as fatigue and sexual dysfunction. Menopausal hormone therapy is an effective treatment for vasomotor symptoms and seems to be safe for many patients with cancer. When hormone therapy is contraindicated or avoided, emerging evidence supports the efficacy of non-pharmacological and non-hormonal treatments, although most evidence is based on women older than 50 years with breast cancer. Vaginal oestrogen seems safe for most patients with genitourinary symptoms, but there are few non-hormonal options. Many patients have inadequate centralised care for managing menopausal symptoms after cancer treatment, and more information is needed about cost-effective and patient-focused models of care for this growing population.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.