The clinical pharmacist’s role in optimising the management of menopausal symptoms in breast cancer survivors: a narrative review

Breast cancer survivors frequently experience menopausal symptoms resulting from treatment-induced ovarian failure, ovarian suppression, and prolonged endocrine therapy. The symptoms may be abrupt and severe, substantially affecting quality of life and complicating survivorship care. Systemic menopausal hormone therapy is generally contraindicated in hormone receptor-positive disease; management relies predominantly on non-hormonal pharmacological therapies, selected local treatments, and supportive non-pharmacological strategies. These interventions are often layered onto complex oncological regimens, increasing the risk of drug–drug interactions and fragmented follow-up. This narrative review synthesises current evidence on non-hormonal management of menopausal symptoms in breast cancer survivors and examines the established and potential roles of clinical pharmacists within oncology and survivorship pathways. A structured MEDLINE search was conducted to identify relevant clinical studies, guidelines, and pharmacist-focused publications. Clinical pharmacists can contribute to structured symptom assessment, optimisation of non-hormonal therapies, identification of pharmacokinetic interactions with endocrine treatments, and facilitation of multidisciplinary communication across oncology, gynaecology, and primary care. Integrating menopause-focused pharmaceutical care into multidisciplinary approaches could enhance symptom management, treatment safety, and patient-centred survivorship support.