New guidelines to help clinicians manage GSM in women with breast cancer

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 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. It is estimated that more than 2 million survivors of breast cancer in the United States are affected by GSM, with most receiving no treatment.

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 individualized 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.

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