Treating Genitourinary Syndrome of Menopause in Postmenopausal Women with a History of Breast Cancer.

Genitourinary syndrome of menopause (GSM) remains widely underdiagnosed and undertreated. It affects up to 60% of breast cancer survivors, is often worsened by oncologic treatments and can progress with age, all leading to diminishing quality of life, particularly in older women. A stepwise, symptom-driven treatment model is recommended-beginning with non-hormonal options and advancing to local vaginal therapies or ospemifene when appropriate. Treatment decisions should be tailored to cancer subtype, receptor status, prior therapies, and time since diagnosis, while also considering symptom burden and patient preferences. Local estrogen is generally safer in tamoxifen users, but caution is warranted with aromatase inhibitors due to potential systemic absorption. In patients with estrogen receptor-negative disease, local hormone use may be considered but requires careful risk-benefit evaluation and shared decision making is essential. Until long-term safety data emerge, management should remain individualized, evidence-based, and multidisciplinary.