Treatment of Urogenital Symptoms in Individuals With a History of Estrogen-dependent Breast Cancer
Summary of Consensus Recommendations
- Nonhormonal methods should be considered first-line treatment for urogenital symptoms in individuals with a history of estrogen-dependent breast cancer.
- Gynecologists should be familiar with different nonhormonal treatment options because trials of multiple options may be needed to find effective treatment for any individual patient.
- Nonhormonal treatments that have been reported to be effective in treating vulvovaginal symptoms include silicone-, polycarbophil-, and water-based lubricants; hyaluronic acid; polyacrylic acid; and vitamin E and D vaginal suppositories. There are insufficient data to indicate that one approach is superior to others.
Hormonal Approaches: Vaginal Estrogen
- If nonhormonal treatments have failed to adequately address symptoms, after discussion of risks and benefits, low-dose vaginal estrogen may be used in individuals with a history of breast cancer, including those taking tamoxifen. For individuals taking aromatase inhibitors (AIs), low-dose vaginal estrogen can be used after shared decision making between the patient, gynecologist, and oncologist.
Dehydroepiandrosterone and Testosterone
- If vaginal estrogen is not an option, vaginal dehydroepiandrosterone (DHEA) or testosterone may help with dyspareunia and improve vaginal tissue health.
Ospemifene/Selective Estrogen Receptor Modulators
- Ospemifene, an orally administered selective estrogen receptor modulator (SERM), has been found to improve symptoms in a general population of menopausal individuals and may be considered as an option for individuals with a history of estrogen-dependent breast cancer. Although there is no indication that ospemifene is associated with increased risk of recurrence, long-term safety data are limited.
Recommendation Grading
Overview
Title
Treatment of Urogenital Symptoms in Individuals With a History of Estrogen-dependent Breast Cancer
Authoring Organization
American College of Obstetricians and Gynecologists
Publication Month/Year
December 1, 2021
Last Updated Month/Year
July 24, 2023
Document Type
Consensus
Country of Publication
US
Inclusion Criteria
Female, Adult, Older adult
Health Care Settings
Ambulatory
Intended Users
Nurse, nurse midwife, physician, nurse practitioner, physician assistant
Scope
Treatment, Management
Diseases/Conditions (MeSH)
D001943 - Breast Neoplasms, D052776 - Female Urogenital Diseases, D014566 - Urogenital System
Keywords
breast cancer, estrogen, urogenital symptoms
Source Citation
American College of Obstetricians and Gynecologists’ Committee on Clinical Consensus—Gynecology. Treatment of Urogenital Symptoms in Individuals With a History of Estrogen-dependent Breast Cancer: Clinical Consensus. Obstet Gynecol. 2021 Dec 1;138(6):950-960. doi: 10.1097/AOG.0000000000004601. PMID: 34794166.