Management of menopause in the breast cancer patient

Many women with breast cancer are menopausal at the time of their cancer diagnosis, and a significant number will enter menopause during treatment. Achievement of adequate control of menopausal symptoms has a meaningful impact on quality of life for breast cancer survivors. Although hormone therapy has proved efficacious in the management of various menopausal conditions, its use in women with a history of breast cancer remains controversial due to a dearth of safety data. This is true even of topical estrogens, which are typically used for vulvovaginal symptoms, given that systemic absorption of unclear significance has been demonstrated in studies. Alternative therapies, such as antidepressants, have proved particularly helpful in the management of vasomotor symptoms, especially considering that comorbid depression is common in this patient population. To counteract the increased risk of bone density loss and fracture, bisphosphonates have emerged as favored treatment, with data suggesting that these agents may also reduce risk of disease recurrence. With advances in diagnosis and treatment, an increasing percentage of women are becoming breast cancer survivors, and comprehensive care of this patient population requires effective management of menopausal symptoms and related disease states.