1. The EPEC-O Curriculum is produced by the EPEC TM Project with major funding provided by NCI, with supplemental funding provided by the Lance Armstrong Foundation. Education in Palliative and End-of-life Care - Oncology The Project EPEC-O TM

2. EPECEPECOOEPECEPECOOO EPECEPECOOEPECEPECOOO Module 3n Symptoms – Menopausal symptoms Module 3n Symptoms – Menopausal symptoms EPEC – Oncology Education in Palliative and End-of-life Care – Oncology

3. Menopause Definition l Primary = amenorrhea > 12 months l Secondary = endocrine disorders, chemotherapy Definition l Primary = amenorrhea > 12 months l Secondary = endocrine disorders, chemotherapy

4. Menopausal symptoms... Impact l Vasomotor symptoms – 75 % l Urinary incontinence l Vaginal dryness l Sexual health Impact l Vasomotor symptoms – 75 % l Urinary incontinence l Vaginal dryness l Sexual health

5. ... Menopausal symptoms Epidemiology l More common in those < 60 years l Improvement over time is usual l Sexual symptoms may persist Epidemiology l More common in those < 60 years l Improvement over time is usual l Sexual symptoms may persist

6. Key points 1.Pathophysiology 2.Assessment 3.Management 1.Pathophysiology 2.Assessment 3.Management

7. Pathophysiology l  Estradiol,  LH,  FSH l Symptoms of estrogen deficiency l Target tissues affected VaginaSkinBone Vascular endothelium Smooth muscle Hypothalamic temperature – regulating center l  Estradiol,  LH,  FSH l Symptoms of estrogen deficiency l Target tissues affected VaginaSkinBone Vascular endothelium Smooth muscle Hypothalamic temperature – regulating center

8. Assessment … l History is the key l “Do you have hot flashes or night sweats?” l “Do you have vaginal dryness or pain with intercourse?” l History is the key l “Do you have hot flashes or night sweats?” l “Do you have vaginal dryness or pain with intercourse?”

9. ... Assessment l “Has the diagnosis of breast cancer or treatment led to a change in your sex life?” l For all symptoms, ask about frequency, severity and the pattern of the symptoms l “Has the diagnosis of breast cancer or treatment led to a change in your sex life?” l For all symptoms, ask about frequency, severity and the pattern of the symptoms

10. Management... Vasomotor symptoms l Hormonal therapy EstrogenProgesterone l Non-hormonal therapies SSRIBellergalGabapentin. Vasomotor symptoms l Hormonal therapy EstrogenProgesterone l Non-hormonal therapies SSRIBellergalGabapentin. Loprinzi. Lancet, 2000. Loprinzi. JCO, 2002. Rossouw. JAMA, 2002.

11. ... Management Vaginal dryness l Non-hormonal lubricants l Silastic ring implanted with estradiol l Vaginal estrogen Vaginal dryness l Non-hormonal lubricants l Silastic ring implanted with estradiol l Vaginal estrogen Ganz. JNCI, 2000.

12. EPECEPECOOEPECEPECOOO EPECEPECOOEPECEPECOOO Summary Use comprehensive assessment and pathophysiology-based therapy to treat the cause and improve the cancer experience