A large portion of 9.3 million breast cancer survivors experience menopause or symptoms of estrogen deficiency due to treatment. Symptoms among cancer survivors may need to be addressed differently than the general population, according to a study published by the Journal of Clinical Endocrinology & Metabolism.

Menopause is a natural part of the aging process, but many women can develop the condition following chemotherapy for breast cancer. These patients may experience premature symptoms of menopause, including sleep disorders, vulvovaginal atrophy, vasomotor symptoms (VMS), mood changes, depression, heart disease, osteopenia, and osteoporosis, according to the study.

While hormone therapy is recommended to treat menopause symptoms, the therapy is not recommended for breast cancer survivors.

In the study, the authors reviewed findings from clinical trials, observational studies, current guidelines, and expert opinions to develop inclusive guidelines for menopause treatment among breast cancer survivors.

The authors recommend that patients should adopt a healthier lifestyle, including smoking cessation, weight loss if needed, limiting alcohol, and eating a healthy diet. Patients should also maintain target levels of vitamin D and calcium, as well as engage in physical activity to relieve menopause symptoms without drugs, according to the study.

Additionally, the authors recommend that VMS symptoms should be treated with cognitive behavioral therapy, hypnosis, and acupuncture among these patients.

Novel approaches, such as selective estrogen receptor modulators, tissue selective estrogen complex, estetrol, and neurokinin B inhibitors show promise as treatments for menopause symptoms, as they are thought to pose less breast cancer risk, according to the study. However, the authors caution there have not been enough studies to confirm the safety of the treatments among patients with a history of breast cancer.

The authors concluded that each patient should receive individualized treatment that meets their needs, while not putting them at risk for recurrent disease.

“Following breast cancer, women should generally not be treated with menopausal hormone therapy but should instead focus on lifestyle modifications such as smoking cessation, weight loss, and regular physical activity,” said first author, Richard J. Santen, MD. “Pharmacologic agents are also available to treat women with severe symptoms. The most important thing to remember is that therapy must be individualized based on each woman’s needs and goals.”