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Improvements in the detection and treatment of breast cancer have resulted in a growing number of breast cancer survivors. It has been estimated that there are now more than 2 million breast cancer survivors in the United States alone, and many more worldwide.1 As these women go on to live healthy and productive lives, many will experience burdensome menopausal symptoms, such as hot flashes and vaginal dryness, and impairments in sexual functioning. Couzi et al2 reported that, of women previously diagnosed with early-stage breast cancer, 65% suffered hot flashes, 44% night sweats, 48% vaginal dryness, 26% dyspareunia, 44% difficulty sleeping, and 44% feeling depressed. Physical and emotional problems arising from the diagnosis and treatment of breast cancer may compound each other, creating a complex interplay of symptoms. Sexual problems may result from a combination of the psychosocial trauma associated with the diagnosis of breast cancer, changes in body image, and treatment side effects. Atrophic vaginitis, a constellation of symptoms including vaginal dryness and associated urogenital inflammation, atrophy, stenosis, pruritus, and dyspareunia, is particularly problematic for sexual functioning.3 Without treatment, these symptoms can be lasting and severe. Speer et al4 found that breast cancer survivors an average of 4.4 years after treatment had reduced sexual functioning in all domains except desire when compared with previously published data on women without a history of cancer. In a direct comparison with age-matched control women, Broeckels et al3 found that women who had been treated for breast cancer at least 5 years previously reported worse sexual functioning including greater lack of sexual interest, inability to relax and enjoy sex, difficulty becoming aroused, and difficulty achieving an orgasm.

Menopausal symptoms may have a substantial impact on quality of life, body image, sexual function, and self-esteem.5,6 These symptoms also impact adherence to hormonal therapies.7 For the approximately 25% of breast cancer patients who are premenopausal at diagnosis, treatment may result in amenorrhea and potential infertility. Menopausal status and fertility potential after breast cancer is an area of great concern for young cancer survivors and may impact treatment decisions.8 Understanding the factors contributing to these symptoms and long-term effects and implementing strategies to avoid or ameliorate them is likely to improve symptoms and quality of life for breast cancer survivors.

Several factors contribute to the development or worsening of menopausal symptoms, sexual dysfunction, and amenorrhea and infertility in breast cancer survivors. Peri- and postmenopausal women generally are recommended to discontinue symptom-relieving hormone-replacement therapy when they are diagnosed with breast cancer. Abrupt withdrawal often precipitates severe hot flashes and vaginal dryness, which weaning more slowly may lessen.9 Surgery and radiation therapy can impair function locally, and systemic therapy including chemotherapy and hormonal therapy may precipitate menopausal symptoms and changes in ovarian function through a number of mechanisms.

Surgical treatments for breast cancer including mastectomy or partial mastectomy and lymph node surgery directly alter a woman's ...

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