How is genitourinary syndrome of menopause (GSM) treated in breast cancer survivors (BCS)?

Updated: Oct 16, 2018
  • Author: Janice L Bacon, MD; Chief Editor: Richard Scott Lucidi, MD, FACOG  more...
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Answer

Breast cancer survivors (BCSs) may suffer genitourinary syndrome of menopause (GSM). This consists of vulvar burning or itching, vaginal dryness or discharge, dyspareunia or post-coital spotting and recurrent urinary tract infections or symptoms of dysuria, frequency or urgency. These symptoms may result from menopause related to surgery, chemotherapy or use of post- treatment medications to reduce risk of recurrence. Genitourinary symptoms frequently arise 1-3 years after the onset of menopause but some women experience them earlier. BCSs are typically not candidates for conventional menopause therapies (eg, systemic hormonal therapy, vaginal estrogens at standard doses) but nonhormonal vaginal moisturizers or lubricants may have limited use over the long term.

Newer management options have become available for all menopausal women experiencing genito-urinary symptoms, including the use of adrenal androgen DHEA in vaginal suppository, low-dose/ultra low-dose topical estrogen cream, tablet or vaginal ring, or an oral selective estrogen receptor modulator ospemifene. Use of these therapies may also reduce the incidence of urinary tract or bladder infections, a cause of significant morbidity in older women. Undiagnosed or untreated urinary infections may lead to urosepsis with an increased risk or long-term morbidity or mortality.

Vaginal laser therapy has been successful for relief of genitourinary symptoms in some women for short periods of time but the studies available are largely observational short-term, patient self-reports and RCT are lacking. This method of therapy is not FDA approved for genitourinary syndrome of menopause, nor supported by scientific organizations. Early detection and individually tailored treatment is vital for improving quality of life in women with GSM as well as for preventing the exacerbation of symptoms. [52]


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