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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. E P E C O 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 … History is the key “Do you have hot flashes or night sweats?” “Do you have vaginal dryness or pain with intercourse?” . . . Assessment “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. E P E C Summary O Use comprehensive assessment and pathophysiology-based therapy to treat the cause and improve the cancer experience