Estrogen Deficiency: In Search of Symptom Control and Sexuality

Extract

Menopausal symptoms can be very prominent problems in women as they approach the age of 50 years and beyond. For at least three reasons, such problems are exacerbated in patients who have had breast cancer. First, cytotoxic chemotherapy in premenopausal women can cause an abrupt menopause, with marked symptoms. Second, the most commonly used antineoplastic drug in the world, tamoxifen, causes, as its most prominent toxic effect, hot flashes. Third, estrogen therapy, the most widely used treatment of women with menopausal symptoms, is often not used in patients with a history of breast cancer because of concerns about what estrogen might do regarding breast cancer.

The article by Ganz et al. (1) in this issue of the Journal describes a group of breast cancer survivors with marked menopausal-associated symptoms. This study incorporated a number of design strengths. The authors used a randomized study method with a control group. Well-established instruments were chosen to measure symptoms and quality of life at baseline and at follow-up times. Sound statistical methods were employed, and the report was clearly written.