Therapeutic Choices for Genitourinary Syndrome of Menopause (GSM) in Breast Cancer Survivors: A Systematic Review and Update

• Published in: Pharmaceuticals (Basel, Switzerland) Vol. 16; no. 4; p. 550
• Main Authors: Merlino, Lucia, D'Ovidio, Giulia, Matys, Viviana, Piccioni, Maria Grazia, Porpora, Maria Grazia, Senatori, Roberto, Viscardi, Maria Federica, Vitale, Antonio, Della Rocca, Carlo, On Behalf Of Policlinico Umberto I Collaborators
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 01-04-2023; MDPI
• Subjects: Amenorrhea; aromatase inhibitors (AI); Breast cancer; breast cancer survivors (BCS); Cancer therapies; Care and treatment; Chemotherapy; Complications and side effects; Demographic aspects; Estrogens; genitourinary syndrome of menopause (GSM); Lasers; Lubricants & lubrication; Medical personnel; Menopause; Menstruation; Ovaries; Quality of life; Risk factors; Systematic Review; Vagina; vaginal lubricants; vaginal moisturizers; vulvovaginal atrophy (VVA); Womens health; Italy; breast cancer survivors (BCS); genitourinary syndrome of menopause (GSM); local hormone therapy; vaginal moisturizers; vulvovaginal atrophy (VVA); vaginal laser therapy; vaginal lubricants; aromatase inhibitors (AI)
• ISSN: 1424-8247; 1424-8247
• DOI: 10.3390/ph16040550

(1) Background: Genitourinary syndrome of menopause (GSM) is a medical condition that can affect breast cancer survivors (BCS). This is a complication that often can occur as a result of breast cancer treatment, causing symptoms such as vaginal dryness, itching, burning, dyspareunia, dysuria, pain, discomfort, and impairment of sexual function. BCS who experience these symptoms negatively impact multiple aspects of their quality of life to the point that some of them fail to complete adjuvant hormonal treatment; (2) Methods: In this systematic review of the literature, we have analyzed possible pharmacological and non-pharmacological treatments for GSM in BCS. We reviewed systemic hormone therapy, local hormone treatment with estrogens and androgens, the use of vaginal moisturizers and lubricants, ospemifene, and physical therapies such as radiofrequency, electroporation, and vaginal laser; (3) Results: The data available to date demonstrate that the aforementioned treatments are effective for the therapy of GSM and, in particular, vulvovaginal atrophy in BCS. Where possible, combination therapy often appears more useful than using a single line of treatment; (4) Conclusions: We analyzed the efficacy and safety data of each of these options for the treatment of GSM in BCS, emphasizing how often larger clinical trials with longer follow-ups are needed.