- An early menopause, estrogen deficiency symptoms and arthralgia are common side effects of systemic breast cancer therapies.
- Symptoms may persist for the duration of treatment and in some cases continue after treatment completion.
- 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.
- 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.
- Lifestyle measures such as weight loss and increased exercise may also improve arthralgias associated with aromatase inhibitors and tamoxifen
- 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.