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Treatment can bring on menopause in a week rather than a decade, and the usual answer, hormone replacement, is often unavailable. The non-hormonal options now have real trial evidence: elinzanetant cut moderate to severe hot flushes by three and a half episodes a day more than placebo in women on endocrine therapy, and venlafaxine and oxybutynin also beat placebo.
Chemotherapy-induced ovarian failure, ovarian suppression, removal of the ovaries and aromatase inhibitors all produce menopausal symptoms, and the abruptness makes them worse than a natural menopause. Hot flushes are the symptom that drives women to stop endocrine therapy early, which is why treating them is not cosmetic.
Neurokinin-targeted drugs are the change. In a phase 3 trial of 474 women taking endocrine therapy for hormone-receptor-positive breast cancer or its prevention, elinzanetant 120 mg daily reduced the mean daily frequency of moderate to severe vasomotor symptoms from a baseline of about 11.4 episodes by 6.5 at week 4 against 3.0 on placebo, a difference of 3.5 episodes (95 per cent confidence interval 4.4 to 2.6), and by 7.8 against 4.2 at week 12. Headache, fatigue and somnolence were the commonest adverse events.
The older options still work. Venlafaxine, in 191 evaluable women with a history of breast cancer or a wish to avoid hormones, reduced median hot flush scores at four weeks by 61 per cent at 75 mg and 150 mg against 27 per cent on placebo. Oxybutynin, in 150 women of whom 65 per cent were taking tamoxifen or an aromatase inhibitor, reduced weekly hot flush score by 16.9 points at 5 mg twice daily and 10.6 at 2.5 mg twice daily against 5.7 on placebo. Behavioural approaches, including cognitive behavioural therapy, paced breathing and hypnosis, are recommended for both sexes by ASCO.
One interaction matters enough to say on its own. Paroxetine and fluoxetine inhibit CYP2D6, the enzyme that converts tamoxifen into its active metabolite. A population-based cohort of women taking tamoxifen found increased breast cancer mortality with overlapping paroxetine use. Venlafaxine is a weak inhibitor and is the usual choice for a woman on tamoxifen. This is a question for the prescriber, not a reason for anyone to stop a tablet on their own.
Bone loss, vaginal dryness and sexual difficulty travel with treatment-induced menopause and have their own records here.
What comes back, and when: it depends on whether the ovaries recover, which is covered in the record alongside this one. Where menopause is permanent, the symptoms themselves usually ease over several years, as they do after a natural menopause, and in the meantime the treatments above have randomised evidence behind them. Vaginal dryness is the exception: it does not improve with time and tends to worsen.
Oestrogen withdrawal narrows the thermoneutral zone in the hypothalamus, so small changes in core temperature trigger flushing and sweating. Neurokinin-3 receptor antagonists act on the hypothalamic KNDy neurons that drive that signal, which is why they work without oestrogen. Serotonin-noradrenaline reuptake inhibitors and anticholinergics act less directly and with smaller effects.
Query for this technology: (TITLE:"Menopause brought on by cancer treatment, and the options for it" OR ABSTRACT:"Menopause brought on by cancer treatment, and the options for it") AND (cancer OR tumor OR tumour OR oncology OR carcinoma OR lymphoma OR leukemia OR leukaemia OR myeloma OR sarcoma OR melanoma OR glioma). Results are unfiltered search hits about Menopause brought on by cancer treatment, and the options for it, not a curated reading list.
Shares Mindfulness-based stress reduction and cognitive therapy, Cognitive behavioural therapy for fatigue and distress, Late effects and survivorship toxicity, Survivorship and late effects are neglected and the tags rejuvenation, survivorship.
Shares Mindfulness-based stress reduction and cognitive therapy, Cognitive behavioural therapy for fatigue and distress, Late effects and survivorship toxicity, Survivorship and late effects are neglected and the tags rejuvenation, survivorship.
Shares Late effects and survivorship toxicity, Survivorship and late effects are neglected, Endometrial cancer, Cervical cancer and the tags rejuvenation, survivorship.
Shares Sexual function and intimacy after cancer, for both sexes, Bone loss caused by cancer treatment, and what rebuilds it, Late effects and survivorship toxicity, Survivorship and late effects are neglected and the tags rejuvenation, survivorship.
Shares Late effects and survivorship toxicity, Survivorship and late effects are neglected, Toxicity and quality of life are undervalued, Endometrial cancer and the tags rejuvenation, survivorship.
Shares Late effects and survivorship toxicity, Toxicity and quality of life are undervalued, Ovarian cancer, Triple-negative breast cancer (TNBC) and the tags rejuvenation, survivorship.
Shares Bone loss caused by cancer treatment, and what rebuilds it, Late effects and survivorship toxicity, Survivorship and late effects are neglected, Toxicity and quality of life are undervalued and the tags rejuvenation, survivorship.
Shares Late effects and survivorship toxicity, Toxicity and quality of life are undervalued, Triple-negative breast cancer (TNBC), HR-positive / HER2-negative breast cancer and the tags rejuvenation, survivorship.