Menopause is marked by irregular menstrual cycles, hormonal changes and is often accompanied by vasomotor symptoms, sleep and mood disturbances, and changes in sexual desire and function. In Australia, almost a third of women will consult a doctor regarding symptoms of menopause [1]. Although not all women are bothered by symptoms of menopause, those with severe symptoms report significant impacts on their quality of life [2]. The symptoms of menopause in patients with a history of cancer are often more severe, owing to the nature and sudden onset of menopause, the need to abruptly cease menopausal hormone therapy (MHT) or the need for ongoing endocrine therapy if indicated. In a study of more than 500 women with a history of breast cancer, more than 60% of survivors had moderate to severe menopausal symptoms affecting both their and their partner’s quality of life. The same study showed that quality of sleep and decreased libido were also problematic in more than 50% of women [3]. Symptom severity can also contribute to poor compliance with prescribed endocrine treatment used to prevent cancer recurrence [4, 5].
Breast cancer is the most common cancer in women worldwide with more than 2 million new diagnoses annually [6]. In Australia, it is estimated that 19,807 women were diagnosed with breast cancer in 2020 [7] and 20–30% are pre-menopausal. Standard treatment (including chemotherapy, radiotherapy, concomitant oophorectomy and/or anti estrogenic endocrine treatment) often results in either early menopause or the exacerbation of pre-existing or previously controlled menopausal symptoms. The Australian Menopause Society states that hormone replacement therapy should be avoided in patients with a history of breast cancer due to the associated risk of new or recurrent cancer [8]. This recommendation is primarily based upon the results of a large randomized control trial that was stopped early in 2003, when an interim safety analysis demonstrated an increased risk of breast cancer recurrence in the MHT arm compared to placebo [9]. With advances in diagnosis and treatment resulting in improved 5-year survival, the number of breast cancer survivors is increasing, translating to a significant quality of life issue for many women [7].
The mainstay of management of menopausal symptoms in women with a history of breast cancer, and other estrogen-sensitive malignancies including endometrioid and low grade serous ovarian carcinomas, advanced endometrial adenocarcinomas and leimyosarcomas, includes lifestyle changes, cognitive behavioral therapy (CBT) and non-hormonal medications such as selective serotonin reuptake inhibitors (SSRI), selective noradrenaline reuptake inhibitors (SNRI), clonidine and gabapentin. A unique multidisciplinary model of care clinic - the Menopause Symptoms After Cancer (MSAC) Clinic - was developed at a tertiary women’s hospital in Western Australia in 2003, and has been replicated throughout Australia and internationally [3]. Women attending the MSAC Clinic receive evidence-based information regarding non-pharmacological and non-hormonal treatments. However, there is limited evidence that such multidisciplinary care improves symptoms, patient satisfaction and quality of life [10]. The aim of the current study was to measure the prevalence of menopausal symptoms at patients’ initial clinic visit and their subsequent follow-up consultation using a validated patient reported outcome measure, the Greene Climacteric Scale, to assess whether menopausal symptoms had improved.