Transcript Module 11 - IPCRC.NET

The
EPEC-O
TM
Education in Palliative and End-of-life Care - Oncology
Project
The EPEC-O Curriculum is produced by the EPECTM Project with major funding
provided by NCI, with supplemental funding provided by the Lance Armstrong
Foundation.
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EPEC – Oncology
Education in Palliative and End-of-life Care – Oncology
Module 3n
Symptoms –
Menopausal symptoms
Menopause
Definition

Primary = amenorrhea > 12 months

Secondary = endocrine disorders,
chemotherapy
Menopausal symptoms . . .
Impact

Vasomotor symptoms – 75 %

Urinary incontinence

Vaginal dryness

Sexual health
. . . Menopausal symptoms
Epidemiology

More common in those < 60 years

Improvement over time is usual

Sexual symptoms may persist
Key points
1. Pathophysiology
2. Assessment
3. Management
Pathophysiology

 Estradiol,  LH,  FSH

Symptoms of estrogen deficiency

Target tissues affected
Vagina
Skin
Bone
Vascular endothelium
Smooth muscle
Hypothalamic temperature – regulating
center
Assessment …

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
History is the key
“Do you have hot flashes or night
sweats?”
“Do you have vaginal dryness or
pain with intercourse?”
. . . Assessment

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“Has the diagnosis of breast cancer
or treatment led to a change in your
sex life?”
For all symptoms, ask about
frequency, severity and the pattern of
the symptoms
Management . . .
Vasomotor symptoms
 Hormonal therapy
Estrogen
Progesterone

Non-hormonal therapies
SSRI
Bellergal
Gabapentin
Loprinzi. Lancet, 2000.
Loprinzi. JCO, 2002.
Rossouw. JAMA, 2002.
. . . Management
Vaginal dryness

Non-hormonal lubricants

Silastic ring implanted with estradiol

Vaginal estrogen
Ganz. JNCI, 2000.
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Summary
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Use comprehensive
assessment and
pathophysiology-based therapy
to treat the cause and improve
the cancer experience