A clinical guide to the management of genitourinary symptoms in breast cancer survivors on endocrine therapy

Abstract

There is increasing attention and concern about managing the adverse effects of adjuvant endocrine therapy for women with early breast cancer as the side effects of therapy influence compliance and can impair quality of life (QoL). Most side effects associated with tamoxifen (TAM) and aromatase inhibitors (AIs) are directly related to estrogen deprivation, and the symptoms are similar to those experienced during natural menopause but appear to be more severe than that seen in the general population. Prolonged estrogen deprivation may lead to atrophy of the vulva, vagina, lower urinary tract and supporting pelvic structures, resulting in a range of genitourinary symptoms that can in turn lead to pain, discomfort, impairment of sexual function and negatively impact on multiple domains of QoL. The genitourinary side effects may be prevented, reduced and managed in most cases but this requires early recognition and appropriate treatment. We provide an overview of practical clinical approaches to understanding the pathophysiology and the management of genitourinary symptoms in postmenopausal women receiving adjuvant endocrine therapy for breast cancer.

Exploring knowledge, attitudes and experience of genitourinary symptoms in women with early breast cancer on adjuvant endocrine therapy

“…Symptoms may include (but are not limited to) vaginal dryness, vaginal soreness, urinary urgency, burning and incontinence and are likely due to the antioestrogenic effect of adjuvant endocrine therapy (Chin et al, 2009;Donovan, Boyington, Ismail-Khan, & Wyman, 2012;Lester et al, 2012). Genitourinary symptoms can negatively affect multiple domains of QoL including sexual functioning (Baumgart, Nilsson, Evers, Kallak, & Poromaa, 2013;Gupta et al, 2006;Lester & Bernhard, 2009;Sousa, Peate, Jarvis, Hickey, & Friedlander, 2017;Zibecchi, Greendale, & Ganz, 2003). Importantly, there have been no qualitative studies exploring the experiences of women taking adjuvant endocrine therapy with respect to genitourinary symptoms, their views about the symptoms and how they impact on their lives.…”

“…Importantly, there have been no qualitative studies exploring the experiences of women taking adjuvant endocrine therapy with respect to genitourinary symptoms, their views about the symptoms and how they impact on their lives. Genitourinary symptoms can negatively affect multiple domains of QoL including sexual functioning (Baumgart, Nilsson, Evers, Kallak, & Poromaa, 2013;Gupta et al, 2006;Lester & Bernhard, 2009;Sousa, Peate, Jarvis, Hickey, & Friedlander, 2017;Zibecchi, Greendale, & Ganz, 2003). Understanding the impact of the genitourinary adverse effects of adjuvant endocrine therapy in women with early breast cancer is a recognised gap in the published literature (Niravath, Rimawi, & Osborne, 2014).…”

Time for Action: Managing Genitourinary Syndrome of Menopause

“…Lifestyle modification such as smoking cessation may help to improve new symptoms, because cigarette smoking is associated with accelerated vulvovaginal atrophy. 9 Women should also be counseled that continuing sexual activity, if possible, can be helpful in managing vaginal dryness, because it can increased blood flow to the genital area, helping keep tissue heathy. Pelvic floor therapy may be a useful treatment for women with nonrelaxing or high-tone pelvic floor muscle dysfunction trigged by painful sexual activity related to GSM.…”

Treatment of vaginal atrophy with estriol and lactobacilli combination: a clinical review

“…After repeated daily intravaginal application of the combination, E3 absorption could no longer be detected, presumably because of increased local metabolism by the matured epithelial maturation. Consequently, this treatment can be evaluated as being safe without any relevant risk of endometrial or other systemic effects and may be considered for breast cancer survivors on aromatase inhibitors 53,74 .…”