Royal Women's Hospital, Melbourne, VIC
Royal Women's Hospital, Melbourne, VIC.
Med J Aust. 2018 Feb 19;208(3):127-132. doi: 10.5694/mja17.00693.
Impaired ovarian function and menopausal symptoms are common after cancer treatment. Menopausal symptoms often occur at an earlier age in women with cancer, and may be more severe than in natural menopause; they may be the most persistent and troubling sequelae of cancer. A third of female patients with cancer report dissatisfaction with the quality and length of physician-patient discussions about reproductive health, including menopause. Systemic menopausal hormone therapy is the most effective treatment for menopausal symptoms, but it is not suitable for all patients after cancer - where it is unsuitable, alternative effective non-hormonal treatments are available. Effective pharmacological agents available to treat vasomotor symptoms include selective serotonin reuptake inhibitors, serotonin-noradrenaline reuptake inhibitors, clonidine and gabapentin. There is increasing evidence supporting cognitive behavioural therapy for the treatment of vasomotor symptoms, in self-help or group settings. Vaginal atrophy can be treated with vaginal (topical) oestrogen with minimal systemic absorption; topical vaginal lubricants may help with vaginal dryness and dyspareunia, with some evidence suggesting that silicone-based products may be more effective than water-based ones. Bone health may be impaired in post-menopausal women with cancer or in cancer survivors, particularly in women with treatment-related menopause or in women receiving anti-oestrogen therapies; this should be managed in addition to menopausal symptoms. Primary care physicians should be aware of the troublesome and ongoing nature of menopausal symptoms after cancer, should discuss them with all patients after cancer treatment, and should consider treatment or referral to a specialist for appropriate management.
癌症治疗后卵巢功能受损和更年期症状很常见。癌症患者的更年期症状往往出现得更早，且可能比自然绝经更严重；它们可能是癌症最持久和令人困扰的后遗症。三分之一的癌症女性患者报告对医生与她们讨论生殖健康（包括更年期）的质量和时长不满意。全身性更年期激素治疗是治疗更年期症状最有效的方法，但并不适用于所有癌症后的患者——对于不适用的患者，有替代的有效非激素治疗方法。可用于治疗血管舒缩症状的有效药物制剂包括选择性 5-羟色胺再摄取抑制剂、5-羟色胺-去甲肾上腺素再摄取抑制剂、可乐定和加巴喷丁。越来越多的证据支持认知行为疗法用于治疗血管舒缩症状，包括自助或小组设置。阴道萎缩可以用阴道（局部）雌激素治疗，全身吸收最小；局部阴道润滑剂可能有助于阴道干燥和性交困难，一些证据表明，硅酮基产品可能比水基产品更有效。癌症或癌症幸存者的绝经后妇女的骨健康可能受损，尤其是有治疗相关绝经或接受抗雌激素治疗的妇女；除了治疗更年期症状外，还应注意这一点。初级保健医生应该意识到癌症后更年期症状的麻烦和持续性质，应该与所有癌症治疗后的患者讨论这些症状，并考虑治疗或转介给专家进行适当的管理。
