Menopause Management in Patients with Cancer: A Symptom‑Based, Risk‑Stratified Framework

Introduction and Context

Menopausal symptoms—vasomotor symptoms (hot flashes, night sweats), genitourinary syndrome of menopause (GSM), sexual dysfunction, mood changes, sleep disturbance, and long‑term cardiometabolic bone health issues—are common in people with cancer. Symptoms may be present at baseline and can be magnified by cancer treatments (chemotherapy, ovarian suppression, pelvic radiation, surgical oophorectomy, and endocrine therapy). The 2026 narrative review by Ward, Mitchem, and Harichand‑Herdt in Obstetrics & Gynecology synthesizes randomized trials, observational studies, systematic reviews, and society statements to produce a practical, symptom‑based, risk‑stratified framework for menopause management in patients with cancer (Ward et al. 2026). This article summarizes the core recommendations and expert perspectives from that review and links them to existing society guidance.

Why this guidance matters now
– Improved cancer survival and growing numbers of young and midlife cancer survivors mean clinicians must manage menopausal symptoms that substantially reduce quality of life.
– New data and growing consensus about nonhormonal therapies, the safety of local vaginal estrogen in many cancer contexts, and the importance of drug–drug interactions (notably with tamoxifen) have clarified safer, individualized approaches.
– Oncologic safety considerations vary by cancer type and hormone sensitivity; a unified, symptom‑based, risk‑stratified approach helps gynecologists and oncologists collaborate effectively.