Hormone Therapy Linked to Poor Sexual Outcomes in Women with Breast Cancer

Hormone Therapy Linked to Poor Sexual Outcomes in Women with Breast Cancer

Women who undergo hormone therapy (also called endocrine therapy) to treat breast cancer often face sexual problems, including vaginal dryness and painful intercourse, according to a recent study.

About two-thirds of breast cancers are hormone receptor-positive. This means that that the cancer cells have receptors that attach to the hormones estrogen and progesterone. These hormones feed the cancer cells and helps them spread. Hormone therapy aims to reduce the amount of hormones available to the cancer cells so that they have less fuel to work with. This may be accomplished in several ways:

  • Tamoxifen. This drug stops hormones and receptors from connecting.
  • Aromatase inhibitors. These drugs stop the body from producing estrogen.
  • Ovarian suppression. This therapy may involve surgical removal of the ovaries (the glands that produce much of a woman’s estrogen and progesterone), drugs that stop the ovaries from making these hormones, or chemotherapy drugs.

The study involved 446 women with a history of breast cancer who were treated at the Memorial Sloan Kettering Cancer Center in New York City. The women underwent pelvic exams and completed questionnaires that assessed their sexual function and vulvovaginal health.

Overall, 77% of the women had finished menopause, 16% were premenopausal or perimenopausal, and the remaining 7% were on ovarian suppression therapy. Some women used either tamoxifen or an aromatase inhibitor alone, some took tamoxifen followed by an aromatase inhibitor, and some had no therapy.

Women who took aromatase inhibitors tended to have the poorest outcomes overall, and those taking tamoxifen were the least sexually active. Almost all of the postmenopausal women – 99% - met the criteria for a sexual dysfunction diagnosis.

Most of the women said they were highly concerned about their sexual function and felt less confident about their sex lives.

The authors explained that hormone therapy can “negatively impact tissue quality.” They pointed out that vulvar atrophy and irritation was a problem for many of the women, as was discomfort in the vestibule (the entrance to the vagina).

Estrogen helps keep vaginal tissue healthy. When estrogen level drops, the vagina can become dry and less elastic, making intercourse uncomfortable.

“The implication here is that we should be intervening early, since it’s necessary to address vulvar atrophy in postmenopausal woman as well as women with ovarian suppression for vulvar irritation,” Dr. Jeanne Carter, lead author of the study, told the ASCO Post.

Dr. Carter continued, “Vestibular irritation, which was present in all groups, from 53% to 70% of patients, is an issue that more people need to be aware of, because it can contribute to insertional pain or pain with exams.” Internal and external moisturizers can relieve symptoms, she added.

The study findings were presented in October 2019 at the Supportive Care in Oncology Symposium in San Francisco, California.

Resources

American Cancer Society

“Breast Cancer Hormone Receptor Status”

(Last revised: September 20, 2019)

https://www.cancer.org/cancer/breast-cancer/understanding-a-breast-cancer-diagnosis/breast-cancer-hormone-receptor-status.html

“Hormone Therapy for Breast Cancer”

(Last revised: September 18, 2019)

https://www.cancer.org/cancer/breast-cancer/treatment/hormone-therapy-for-breast-cancer.html

American Society of Clinical Oncology

Carter, Jeanne, et al.

“Breast cancer patients in a female sexual medicine and women’s health program: A cross-sectional retrospective study.”

(Abstract #8, presented at the 2019 Supportive Care in Oncology Symposium in San Francisco, California, October 2019)

https://abstracts.asco.org/245/abstview_245_277435.html

The ASCO Post

Doyle, Chase

“Study Finds Sexual Health Issues are a Concern Among Majority of Women With Breast Cancer”

(November 25, 2019)

https://www.ascopost.com/issues/november-25-2019/study-finds-sexual-health-issues-are-a-concern-among-majority-of-women-with-breast-cancer/

Medscape.com

Nelson, Roxanne, RN, BSN

“Ask About Sexual Function in Breast Cancer Patients on Endocrine Tx”

(October 31, 2019)

https://www.medscape.com/viewarticle/920631#vp_2