"A large proportion of the worlds estimated . million breast cancer survivors experience menopausal symptoms or clinical manifestations of estrogen deficiency. A comprehensive review httpsacademic.oup.comjcemarticleManagingmenopausalsymptomsandassociated published in the Endocrine Societys Journal of Clinical Endocrinology  Metabolism focuses on current and future approaches to management of menopausal symptoms after breast cancer. Menopause is a normal part of a womans aging process but premenopausal women treated with chemotherapy can also develop premature menopause and consequently severe menopausal symptoms including sleep disorders vulvovaginal atrophy VVA vasomotor symptoms VMS mood changes depressive symptoms cardiovascular disease osteopenia and osteoporosis. Hormone therapy may help relieve a womans menopausal symptoms but is not recommended for women who have had breast cancer. Following breast cancer women should generally not be treated with menopausal hormone therapy but should instead focus on lifestyle modifications such as smoking cessation weight loss and regular physical activity said the studys first author Richard J. Santen M.D. of the University of Virginia Health System in Charlottesville Va. Pharmacologic agents are also available to treat women with severe symptoms. The most important thing to remember is that therapy must be individualized based on each womans needs and goals. Santen and colleagues reviewed controlled clinical trials observational studies evidencebased guidelines and expert opinion from professional societies to address the gap in treatment recommendations for management of menopausal symptoms after breast cancer.  The reviews recommendations include  Smoking cessation weight loss if indicated limiting or avoiding alcohol maintaining adequate levels of vitamin D and calcium eating a healthy diet and regular physical activity are suggested for all women with prior breast cancer   Nonpharmacologic therapies for VMS such as cognitive behavioral therapy hypnosis and acupuncture may be helpful as are vaginal lubricants and moisturizers   Several emerging approaches such as selective estrogen receptor modulators SERMs Tissue selective estrogen complex TSECs estetrol and neurokinin B inhibitors show promise as useful agents to expand options for symptom relief with less breast cancer risk but have not yet been tested to confirm safety in women with prior breast cancer  Other authors of the study include Cynthia A. Stuenkel of the University of California San Diego in La Jolla Calif. Susan R. Davis of the School of Public Health and Preventative Medicine Monash University in Australia JoAnn V. Pinkerton of the University of Virginia in Charlottesville Va. Ann Gompel of Paris Descartes University in France and Mary Ann Lumsden of the University of Glasgow School of Medicine Dentistry and Nursing in Scotland. The study Managing Menopausal Symptoms and Associated Clinical Issues in Breast Cancer Survivors is published online at httpsacademic.oup.comjcemarticleManagingmenopausalsymptomsandassociated ahead of print.  Endocrinologists are at the core of solving the most pressing health problems of our time from diabetes and obesity to infertility bone health and hormonerelated cancers. The Endocrine Society is the worlds oldest and largest organization of scientists devoted to hormone research and physicians who care for people with hormonerelated conditions.  The Society has more than  members including scientists physicians educators nurses and students in  countries. To learn more about the Society and the field of endocrinology visit our site at http Follow us on Twitter at TheEndoSociety httpstwitter.comTheEndoSocietyref_srctwsrcEgoogleCtwcampEserpCtwgrEauthor and EndoMedia httpstwitter.comendomedialangen."