When women find out they have breast cancer, many leave their ob-gyn and go to a cancer specialist. After treatment, they return to their ob-gyn.

Although their cancer is gone, cancer-related health issues remain. Concerns about fertility, birth control, menopause, and bone health are common.

If you are one of these estimated 2 million breast cancer survivors in the U.S., your ob-gyn now has new guidance. The American College of Obstetricians and Gynecologists has issued a practice bulletin with new information on how to manage these health issues.

"More and more women are living with breast cancer, and all these [cancer] drugs have gynecologic side effects," says Mindy Goldman, MD, a clinical professor of obstetrics and gynecology and director of the Women's Cancer Care Program at the University of California San Francisco. She developed the report with the ACOG's Committee on Practice Bulletins, Gynecology.

The guidelines are published in Obstetrics  & Gynecology.

As more ob-gyns read the new guidelines, "I think women should feel more comfortable in asking questions of their ob-gyns and hopefully get answers," Goldman says.

A Visual Guide to Breast Cancer

Breast Cancer Survivors & Gynecology Issues

Breast cancer survivors can have both short-term and long-term side effects, according to the guidelines. Among those:

• Hot flashes
• Vaginal dryness
• Osteoporosis
• Premature menopause
• Loss of fertility
• Body image problems
• Sexual problems, including painful sex

The guidelines offer options to deal with the issues, based on scientific evidence.

Birth control options, for instance, can include barrier methods such as condoms and diaphragms, the copper IUD, and sterilization, the guidelines say. 

The use of the cancer drug tamoxifen is addressed. "It's well-known that tamoxifen can increase uterine cancer risk in postmenopausal women," Goldman tells WebMD. "It turns out it's pretty rare and almost always [occurs] with abnormal bleeding."

For that reason, the guidelines suggest that a routine biopsy and ultrasound are not needed if women past menopause take the drug but do not have bleeding.

Other information:

• Pregnancy after breast cancer is not thought to raise the risk of recurrence.
• Younger breast cancer patients who want to have children should be referred to a fertility specialist. It may be possible to freeze eggs before treatment starts.
• Antidepressants can help relieve hot flashes that can occur with cancer drugs.
• Drugs to preserve bone should be considered if bone density becomes low.
• Vaginal lubricants without hormones can help vaginal dryness, which is linked with sexual dissatisfaction.

Goldman has served as a consultant on hormone therapy and breast cancer risk for Wyeth, which is now part of Pfizer and makes a hormone replacement drug.

Breast Cancer Survivors: Guidelines Should Help Ob-Gyns

The guidelines will be a valuable reminder and update for ob-gyns, says Mark Wakabayashi, MD, MPH, chief of gynecologic oncology at the City of Hope Comprehensive Cancer Center in Duarte, Calif. He reviewed the guidelines for WebMD.

It is difficult for ob-gyns to keep up with how to treat all the side effects of breast cancer, and the new guidelines should help them, he says.

For women returning to their ob-gyn, Wakabayashi gives this advice: "Your physician should be aware of what treatment you are on [or have finished] and the problems."

Before a visit to the ob-gyn, he adds, "Make a list of things that are bothering you." Take it to the visit.

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