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Nonpharmacological therapies for the management of menopausal vasomotor symptoms in breast cancer survivors

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Abstract

Purpose

Breast cancer affects millions of women worldwide, and for many, therapy results in treatment-induced menopause. Menopausal symptoms in breast cancer survivors are often more severe, frequent, and of greater duration compared with natural menopause. Hot flushes and night sweats pose a significant burden for many women, with limited therapeutic options as menopausal hormone therapy is contraindicated. Guidelines recommend non-hormonal pharmacological agents including clonidine, gabapentin, and some antidepressants. However, some women may be reluctant to use medications due to concerns about side effects. The aim of this narrative review was to appraise recent evidence for nonpharmacological treatments for vasomotor symptoms in breast cancer survivors including cognitive behavioural therapy, hypnosis, yoga, mindfulness, acupuncture, and lifestyle changes.

Methods

A literature search was conducted. Studies were included if they were randomised and involved breast cancer survivors and nonpharmacological treatments for menopausal vasomotor symptoms.

Results

Twelve studies met the criteria, and three studies of exercise in healthy menopausal women were included. Cognitive behavioural therapy reduces menopausal symptoms and perceived impact of hot flushes and night sweats in breast cancer survivors and is cost effective. The efficacy of hypnosis as a treatment for menopausal vasomotor symptoms in women with breast cancer is supported by two randomised controlled trials. Yoga and acupuncture may reduce vasomotor symptom frequency and/or burden. Studies of exercise as an intervention for vasomotor symptoms in healthy menopausal women have not shown benefit.

Conclusion

Evidence for nonpharmacological interventions supports cognitive behavioural therapy and hypnosis in the management of vasomotor symptoms in breast cancer survivors.

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Authors and Affiliations

  1. Division of Obstetrics and Gynaecology, Faculty of Health and Medical Sciences, University of Western Australia, Crawley, WA, 6009, Australia

    Stephanie Tran & Paul A. Cohen

  2. Department of Obstetrics and Gynaecology, University of Melbourne, Level 7, Royal Women’s Hospital, 20 Flemington Road, Parkville, VIC, 3052, Australia

    Martha Hickey

  3. Division of Surgery, School of Medicine, University of Western Australia, Crawley, WA, 6009, Australia

    Christobel Saunders

  4. Menopause Symptoms After Cancer Clinic, King Edward Memorial Hospital, Subiaco, WA, 6008, Australia

    Lesley Ramage

  5. Department of Gynaecological Oncology, St John of God Subiaco Hospital, Subiaco, WA, 6008, Australia

    Paul A. Cohen

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  1. Stephanie Tran
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  2. Martha Hickey
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  3. Christobel Saunders
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  4. Lesley Ramage
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  5. Paul A. Cohen
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Contributions

Stephanie Tran conceived the idea for the literature review, performed the literature search, and wrote the first draft. Paul Cohen, Martha Hickey, Christobel Saunders, and Lesley Ramage critically revised the work. All authors read and approved the final manuscript.

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Correspondence to Stephanie Tran.

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Tran, S., Hickey, M., Saunders, C. et al. Nonpharmacological therapies for the management of menopausal vasomotor symptoms in breast cancer survivors. Support Care Cancer 29, 1183–1193 (2021). https://doi.org/10.1007/s00520-020-05754-w

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