(288) Menopausal and Sexual Symptom Management and Treatment Utilization Patterns Among Young Breast Cancer Survivors

Abstract Introduction Breast cancer is the most common malignancy among women, and more than 4 million in the United States are living as survivors. Approximately 70–80% of cases are estrogen receptor–positive (ER+) and treated with long-term endocrine therapy (ET). For women who are pre- or perimenopausal at diagnosis, ET suppresses ovarian function and induces abrupt, treatment-related menopause, leading to vasomotor, musculoskeletal, genitourinary, and sexual symptoms that can persist for years and significantly impair quality of life. Although guidelines exist for managing genitourinary syndrome of menopause (GSM) in breast cancer survivors, only 39% receive treatment despite 70% reporting symptoms. Limited provider communication and patient discomfort discussing sexual health contribute to this gap. Objective The study examined among pre- and perimenopausal breast cancer survivors on ET: (1) sexual functioning after diagnosis, (2) communication with providers about menopausal and sexual health symptoms and treatment recommendations, and (3) patient utilization and perceived effectiveness of GSM treatments. Methods We recruited 505 women with a history of ER+ breast cancer diagnosed between ages 24 and 51 (M = 42.8). The analytic subsample included 109 participants who self-reported being pre- or perimenopausal. Participants were identified through electronic health records and contacted via MyChart or mailed invitations that included a small financial incentive. Surveys were administered through REDCap and included the FSFI-BC, FACT-G, Menopause Checklist, and custom questions on treatment use and perceived effectiveness. Results Nearly three-quarters (74.7%) of the sample reported a decline in sexual function after diagnosis, and about one in four (23.6%) experienced distress about their sexual functioning at least half the time. Eighteen percent reported no sexual activity of any kind, most commonly due to orgasm (50%), lubrication (46.2%), desire/arousal (40%), or pain difficulties (23.1%). The three most bothersome menopausal symptoms were loss of desire (40.5%), urinary frequency (20.3%), and dryness (11.4%). Two-thirds (67%) recalled a discussion with a provider about treatment-related menopause, but only 25.8% sought help for sexual or menopausal symptoms. Among those who did, non-hormonal vaginal moisturizers and lubricants were most common, rated as moderately to highly effective by 66.7% and 100% of respondents, respectively. Continuation rates after six months were 40% for moisturizers and 71.4% for lubricants. Conclusions These findings show that younger breast cancer survivors on endocrine therapy experience significant sexual changes but rarely receive the guidance or follow-up needed to manage them. Most had at least one conversation about menopause, yet few were offered practical support or individualized care. The disconnect between symptom burden and treatment use reflects both systemic and interpersonal barriers that prevent open discussion and coordinated management. Even simple, low-risk treatments were viewed as effective when provided, underscoring the potential of early, proactive care. Improving outcomes will require that sexual and menopausal health become a routine part of survivorship rather than an optional discussion. Regular screening, patient education, and provider training can help ensure that these topics are addressed consistently and compassionately. For premenopausal survivors, maintaining sexual wellbeing is not an afterthought but a key component of long-term recovery and overall quality of life. Disclosure No