Although the genitourinary syndrome of menopause (GSM) is
more prevalent in survivors of breast cancer than in other menopausal women, it
is commonly undiagnosed and untreated.
This led the North American Menopause Society (NAMS) and The
International Society for the Study of Women’s Sexual Health (ISSWSH) to form a
multidisciplinary Consensus Panel to develop recommendations for clinicians to
manage GSM in women with or at high risk for breast cancer. The recommendations
are published online in the June issue of NAMS’ official journal, Menopause. For survivors of breast
cancer, not only is GSM more prevalent, but these women may experience its
symptoms earlier because of cancer treatments. With the lack of data regarding
the safety of vaginal hormone treatments and other alternatives for women with
or at high risk for breast cancer, many have avoided using hormone treatments,
and clinicians have often been reluctant to prescribe them.
Left untreated, GSM can potentially adversely affect quality
of life and partner relationships because of ongoing symptoms, including
vulvovaginal dryness, burning, or irritation; painful intercourse; and
recurrent urinary tract infections.
The Consensus Panel of 16 experts created the consensus
recommendations after a comprehensive, evidence-based review of existing
literature. In addition, the Consensus Panel agreed that decision- making
regarding the type of treatment for GSM should be individualised and include
balancing the risk of cancer recurrence with the severity of symptoms and
effect on quality of life.
The recommendations offer clinicians caring for this
population of women some guidance regarding therapeutic decision making in the
absence of clinical trial data. “We want clinicians caring for this at-risk
population to be armed with as much information as possible so that they can
provide the best course of treatment for their patients,” says Dr JoAnn
Pinkerton, executive director of NAMS.
“Until additional studies are undertaken in this area, we
are hopeful these consensus recommendations will provide added confidence for
clinicians to move forward with treatment options that will provide relief to
women from GSM symptoms.”
of Genitourinary Syndrome of Menopause in Women With or at High Risk for Breast
Cancer: Consensus Recommendations. Menopause. June 2018 – Volume 25 – Issue 6