Cited source

Genitourinary syndrome of menopause in women with cancer - a narrative review

Ryan HM, Brennan DJ (2026)

Maturitas · PMID 42224847

Abstract

This review explores the use of local vaginal estrogen therapy for managing genitourinary syndrome of menopause by survivors of hormone-sensitive breast and gynaecological cancer, emphasizing its role in improving quality of life and alleviating symptoms such as vaginal dryness, dyspareunia and recurrent urinary tract infections. Treatments for hormone-sensitive cancers often cause sudden menopause, and prolonged use of endocrine therapies can worsen the symptoms of genitourinary syndrome of menopause. The syndrome is frequently under-recognized and inadequately managed, and women should be screened and educated about symptoms and treatment options, especially survivors of breast and gynaecological cancer. Shared decision-making is central to managing genitourinary syndrome of menopause in hormone-sensitive cancers, as options balance the side-effects of cancer treatments and endocrine therapies against quality of life. While nonhormonal therapies are recommended as first-line treatment, if ineffective, low-dose vaginal estrogen provides significant symptom relief and efficacy in easing genitourinary symptoms and reducing urinary tract infections with minimal systemic absorption. While caution has traditionally been suggested in estrogen-sensitive cancers, the use of vaginal estrogen therapy by women with breast cancer receiving endocrine therapy with tamoxifen or aromatase inhibitors and by women with hormone-sensitive gynaecological cancers is discussed. Interpreting safety data-especially for hormone-sensitive cancers-requires careful, individualized decision-making in collaboration with oncology teams. Individualized care is essential to balance symptom relief, patient safety and compliance with treatments, optimizing outcomes and quality of life for these patients. The paper highlights the need for additional research on long-term safety and efficacy across cancer subtypes to improve personalised care.