The management of menopausal symptoms after cancer or risk-reduction surgery? A move towards consensus

摘要

Introduction: For women who survive reproductive cancers, menopausal symptoms following treatment can be a significant problem affecting quality of life and wellbeing. Information regarding hormonal treatment including hormone replacement therapy is a matter of debate, particularly following treatment for endo-metrial or ovarian cancer. Women will therefore often have received conflicting advice and may approach specialist menopause clinics in some desperation for help with management of symptoms. A woman with cancer or at high risk of cancer will have seen numerous multi-disciplinary healthcare professionals, many of whom may underestimate the impact that menopausal symptoms have on quality of life, especially in younger sexually active women. The aim of this study was to examine referral patterns and symptom profiles of women with cancer or cancer risk, to identify areas where a more integrated approach to management might be required and to reach a local consensus across disciplines involved in the care of these women.Methods: The Edinburgh Menopause Clinic provides the only specialist menopause service for NHS Lothian. The case records are fully computerised. A retrospective case record review of all new referrals between 201 I and 2012 for the management of cancer-related menopausal symptoms was undertaken. The results of the review were discussed at a meeting with specialists from hospital gynae-oncology, oncology and clinical genetics.Results: Fifty-nine new patients had been referred for the management of menopausal symptoms and had had previous treatment for cancer (34), or were women with a confirmed risk factor and were considering, or had undergone, risk-reduction surgery (15). Menopausal symptoms were common and often severe in this population. The majority of women reported severe vasomotor symptoms; vaginal dryness and sexual difficulties were also common and the mean age of women with these problems was 41 years.Management was agreed at the multidisclipinary meeting and a regional guidance document written thereafter. There has been an immediate improvement in the sharing of information between departments.