Management of genitourinary syndrome of menopause in women with or at high risk for breast cancer: consensus recommendations from The North American Menopause Society and The International Society for the Study of Women's Sexual Health.
Level 5 - mechanism / opinion, no new human data
Expert consensus panel using a modified Delphi method without new primary data
PubMed 29762200 · doi:10.1097/GME.0000000000001121
What was done
The North American Menopause Society (NAMS) and the International Society for the Study of Women's Sexual Health (ISSWSH) convened a 16-member multidisciplinary expert panel. Panelists reviewed the literature in their respective areas and utilized a modified Delphi process—involving presentations, debate, and iterative discussion—to construct a point-of-care clinical management algorithm for genitourinary syndrome of menopause (GSM) in women with or at high risk for breast cancer (including estrogen-receptor positive, triple-negative, and metastatic subgroups).
What was found
The abstract reports no empirical numbers or quantitative effect sizes. It reports that GSM is common and often untreated in breast cancer survivors. The panel determined that GSM management must be individualized, with nonhormonal therapies serving as first-line treatment. Local hormone therapies may be considered for women who fail nonhormone interventions following a discussion of risks and benefits in consultation with their oncologist.
Why it matters
This statement provides practical clinical guidance for treating debilitating GSM symptoms in breast cancer survivors while navigating the oncologic risks and substantial evidence gaps surrounding vaginal hormone therapy.
Limits
The recommendations represent expert consensus based on modified Delphi methodology rather than a systematic review or randomized trial, providing no new patient data. The abstract explicitly highlights substantial gaps in the evidence regarding the safety of vaginal hormone therapies in this population.
Cited by
- supports The medical consensus is that women with a past history of breast cancer who cannot use systemic estrogen therapy may safely be candidates for vaginal estrogen use.