Treatment of Urogenital Symptoms in Individuals With a History of Estrogen-dependent Breast Cancer

Publication Date: December 1, 2021
Last Updated: March 14, 2022

Summary of Consensus Recommendations

Nonhormonal Approaches
  • 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.

Nonhormonal and Hormonal Treatment Options

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Overview

Title

Treatment of Urogenital Symptoms in Individuals With a History of Estrogen-dependent Breast Cancer

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