Does a multidisciplinary menopausal symptoms after cancer clinic reduce symptoms?

PURPOSE: This study aimed to measure the prevalence of menopausal symptoms in patients attending a multidisciplinary model of care clinic at their initial clinic visit and their subsequent follow-up consultation using a validated patient-reported outcome measure to assess whether menopausal symptoms after cancer had improved. METHODS: A retrospective review was conducted of patients attending the clinic in a 12-month period in 2017 (n = 189). Recorded variables included patient demographics, details of index cancer, previous treatments, and menopausal symptom management strategies. Severity of menopausal symptoms was evaluated using the Greene Climacteric Scale. The extent to which patients were bothered by symptoms was combined into two categories and dichotomized (present/absent). Differences in symptom prevalence between the initial consultation and first follow-up visit were examined using McNemar's test. RESULTS: The majority of patients attending the clinic had a history of breast cancer (72%). Fifty-five percent of patients were prescribed a non-hormonal therapy at their initial visit, most commonly gabapentin. Significantly fewer patients reported being bothered by hot flushes, fatigue, sleep difficulties, and loss of interest in sex, anxiety, or troubles concentrating at the first follow-up visit compared to their initial consultation (p < 0.01). CONCLUSION: In this study, there was an improvement in self-reported menopausal symptoms in a significant proportion of cancer survivors attending a multidisciplinary menopause clinic between their initial and first subsequent follow-up consultations.

Abnormal bleeding in postmenopausal hormone users-What do we know today?

Whilst use of estrogen-containing hormone therapy (HT) has declined in recent years, it is still used by a significant minority of women and remains the most effective way of treating menopausal vasomotor symptoms and vaginal dryness. Unscheduled vaginal bleeding and spotting is a common unwanted effect of combined HT. This abnormal bleeding is inconvenient and commonly leads to invasive tests to exclude underlying pelvic pathology. The mechanisms underlying unscheduled bleeding with HT are poorly understood and there are no evidence-based treatment options. Relatively few studies have investigated how combined hormone therapy induces changes in the endometrium which may predispose to increased bleeding. The available evidence suggests that combined HT induces changes in endometrial blood vessels and stroma which may increase vascular fragility. An improved understanding of how combined HT changes the endometrium to induce bleeding may lead to targeted therapies to effectively prevent or resolve bleeding in postmenopausal women. This will improve the acceptability of combined HT and have personal benefits for postmenopausal women and financial benefits for healthcare providers. This review will discuss current evidence and potential mechanisms underlying unscheduled bleeding with combined HT.