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

TreatmentsBreast cancer effectsGSM effectsNotes
Endocrine therapy
Aromatase inhibitorsEffective in suppressing serum estrogen
Indicated for treatment of estrogen receptor-positive breast cancers in postmenopausal women
Vaginal dryness, atrophic vaginitisThird-generation aromatase inhibitors—anastrozole, exemestane, and letrozole—have largely replaced tamoxifen as the preferred treatment for hormone receptor-positive breast cancer in postmenopausal women
TamoxifenIndicated for metastatic breast cancer, adjuvant treatment of breast cancer, and to reduce breast cancer incidence in women at high riskVasomotor symptoms, vaginal dryness, and low libidoLower rates of vaginal dryness than with aromatase inhibitors; may actually inhibit or improve vaginal dryness induced by chemotherapy or menopause
Chemotherapy, biologic therapy, hormonal therapyDecrease levels of estrogen and progesterone, which improves clinical outcomes for breast cancerVaginal dryness, atrophic vaginitis, other symptoms of estrogen lossEffective 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
  • Based on information in reference 1.