Key points

  1. An early menopause, estrogen deficiency symptoms and arthralgia are common side effects of systemic breast cancer therapies.
  2. Symptoms may persist for the duration of treatment and in some cases continue after treatment completion.
  3. The NICE Menopause Guidance [NG23] recommends referral of women to a healthcare professional with expertise in gynaecological endocrinology for counselling about the risk of developing an early menopause and the management of symptoms associated with breast cancer treatment.
  4. Lifestyle measures and non-hormonal interventions should be first-line management for estrogen deficiency symptoms but if these are ineffective systemic hormone replacement therapy or low-dose topical estrogen may be considered but only after taking specialist advice.
  5. Lifestyle measures such as weight loss and increased exercise may also improve arthralgias associated with aromatase inhibitors and tamoxifen
  6. Switches to endocrine breast cancer treatment may alleviate symptoms of estrogen deficiency and arthralgia but these should only be instigated in secondary care by the breast specialist team.
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Written: November 2018
Next review date: November 2021