TABLE 1

Systemic breast cancer treatments that cause genitourinary syndrome of menopause (GSM)

Treatments	Breast cancer effects	GSM effects	Notes
Endocrine therapy
Aromatase inhibitors	Effective in suppressing serum estrogen Indicated for treatment of estrogen receptor-positive breast cancers in postmenopausal women	Vaginal dryness, atrophic vaginitis	Third-generation aromatase inhibitors—anastrozole, exemestane, and letrozole—have largely replaced tamoxifen as the preferred treatment for hormone receptor-positive breast cancer in postmenopausal women
Tamoxifen	Indicated for metastatic breast cancer, adjuvant treatment of breast cancer, and to reduce breast cancer incidence in women at high risk	Vasomotor symptoms, vaginal dryness, and low libido	Lower rates of vaginal dryness than with aromatase inhibitors; may actually inhibit or improve vaginal dryness induced by chemotherapy or menopause
Chemotherapy
Chemotherapy, biologic therapy, hormonal therapy	Decrease levels of estrogen and progesterone, which improves clinical outcomes for breast cancer	Vaginal dryness, atrophic vaginitis, other symptoms of estrogen loss	Effective therapies but can induce symptoms of estrogen loss that negatively affect long-term vaginal health and quality of life; increase risk of ovarian failure in premenopausal women