1. The menopause and breast cancer
Breast cancer treatments such as , hormone (endocrine) therapy or can cause menopausal symptoms.
Some women find these symptoms manageable, but many find they are difficult to cope with and can affect their quality of life.
In premenopausal women, some treatments may cause an early menopause, leading to the symptoms described below. Some treatments will not cause an early menopause but may cause the symptoms associated with it.
Some women may be on hormone replacement therapy (HRT) when they are diagnosed with breast cancer. HRT is given to help with the symptoms of the menopause, but is not usually recommended for women with breast cancer. Therefore, if you are taking HRT when diagnosed you’ll probably be advised to stop. Talk to your treatment team for advice about how best to do this. Stopping HRT can cause menopausal symptoms to return.
You may have already been through the menopause, but having breast cancer treatment can cause you to have symptoms again.
2. Common menopausal symptoms
Some of the most common menopausal symptoms include:
- Hot flushes
- Night sweats
- Vaginal dryness
- Changes to how you experience orgasm
- Changes to sex drive
- Heart palpitations
- Mood changes
- Joint pain
- Changes to skin and hair
- Weight gain, particularly around the waist
- Difficulty sleeping
- Memory and concentration problems
- Feeling anxious or irritable
- A crawling sensation under the skin
The changes in your body may be gradual, but for some women symptoms can start suddenly.
3. What breast cancer treatments can cause menopausal symptoms?
Hormone (endocrine) therapies
The hormone therapies tamoxifen, anastrozole, letrozole and exemestane can all cause menopausal symptoms.
Find out more about hormone therapies.
Ovarian suppression means stopping the ovaries from making oestrogen, either temporarily or permanently. You may also hear it called ovarian function suppression and ovarian ablation.
Ovarian suppression can be carried out using:
- Hormone therapy – the most commonly used drug is goserelin but you may also have triptorelin or leuprorelin
- Surgery to remove the ovaries
- Radiotherapy to the ovaries
The natural menopause is a gradual process, whereas ovarian suppression can bring on menopausal symptoms suddenly and they may be more intense.
Find out more about ovarian suppression.
If you haven’t been through your natural menopause, chemotherapy might cause your periods to stop. This is because the ovaries, which produce oestrogen, are affected by the treatment.
For some women this may cause an earlier, more sudden menopause. Symptoms are often more intense than when the menopause occurs naturally.
Sometimes periods stop temporarily. In this case menopausal symptoms will improve when your periods return. This might be several months or occasionally even years after your chemotherapy has finished.
Find out more about chemotherapy.
4. Can I still get pregnant?
Fertility and breast cancer treatment
Even if you stop having periods and experience menopausal symptoms, you may still be fertile and could become pregnant. You may also still be fertile even if you are going through the menopause, as your ovaries might not have stopped working completely.
If you are unsure about your fertility or menopausal status, talk to your treatment team or GP, who can discuss contraception where appropriate.
Sometimes your treatment team may suggest having a series of blood tests to check if you are pre or postmenopausal, but this isn’t appropriate or accurate for everyone and will depend on where you are in your treatment.
For some women, having an early menopause may mean coming to terms with the possibility of being infertile. This can be very difficult to cope with, especially if you’re considering starting a family or having more children.
5. Managing menopausal symptoms
Sometimes menopausal symptoms can be severe and have a significant impact on your quality of life.
Your decisions about how to try to manage them may depend on how severe your symptoms are and the likely side effects of any treatments.
Our booklet Menopausal symptoms and breast cancer includes a ‘checklist’ for recording the symptoms you’re experiencing, to help you start a discussion with your GP or breast care nurse.
It’s also worth asking your GP or breast care nurse if there’s a specialist menopause clinic in your local area where you can get further advice and information about coping with menopausal symptoms.
Hot flushes and night sweats
Find out about hot flushes and night sweats.
Vaginal dryness is a common, often distressing symptom in women who have had treatment for breast cancer.
If it’s not treated it can get worse, so it’s important to get help if you need it.
Vaginal dryness and irritation can also be caused by infection, so it’s best to visit your GP to rule this out.
There are a number of treatments that can help with vaginal dryness, including vaginal moisturisers and lubricants. You may be able to get these on prescription from your GP, or you can buy them from a chemist or online.
Find out more about the treatments for vaginal dryness.
Stress, anxiety and mood changes
You may feel anxious or stressed.
Sometimes feelings of anxiety can be linked to low mood and depression.
It may help to talk through your feelings with your treatment team or GP. They can tell you if they think more specialist psychological help would be useful.
Some people find relaxation techniques such as visualisation (focusing your imagination to create images), distraction (focusing on things around you) and yoga help to reduce stress and anxiety.
Mindfulness involves focusing on what’s happening now – on yourself, your thoughts and what’s going on around you – and can help to stop your mind from wandering.
Intimacy, sex and breast cancer
Menopausal symptoms such as hot flushes, night sweats and vaginal dryness as well as a decreased sex drive can affect new and existing relationships and your sex life.
It may feel difficult or embarrassing talking about these problems, but it can help to discuss it with your treatment team or GP as they may be able to help.
Some women experience bladder problems such as passing urine more frequently, developing a urinary tract infection (UTI) and sometimes incontinence.
If you have a burning pain when passing urine or are passing small amounts of urine frequently, it’s worth checking with your GP to see if you have a UTI.
Pelvic floor exercises may help to improve your bladder control. You can read how to do pelvic floor exercises on the NHS website.
Putting on weight
Weight changes, especially around the waist, are common during both cancer treatment and the menopause. Maintaining a healthy weight is important for long-term health.
There are many ways to avoid gaining weight and to lose any extra weight you may have put on.
Your treatment team or GP can give you more information on achieving a healthy weight, and they can refer you to a dietitian for further advice if necessary.
Joint pain and risk of osteoporosis
Joint pain or aching joints are common menopausal symptoms and also a side effect of some breast cancer treatments.
If you’re experiencing joint pain, tell your treatment team or GP who may be able to suggest things to help relieve it.
Lower oestrogen levels may harm your bones and cause osteoporosis.
During and after the menopause, bones become less strong and the body is less able to repair any damaged or weakened areas. This can result in pain and as the bones become fragile they can break (fracture) with little or no force.
Your treatment team may arrange for you to have a DEXA (dual energy x-ray absorptiometry) scan, which uses x-rays to work out the density and strength of your bones, if:
- Your menopause was brought on by cancer treatment
- You are starting ovarian suppression (treatment preventing the ovaries from producing oestrogen)
- You are going to be taking an aromatase inhibitor
A well-balanced diet, regular physical activity, not smoking and limiting alcohol are all important for bone health.
Feeling fatigued or constantly tired is another common symptom of the menopause and can be a side effect of treatments for breast cancer.
Feelings of tiredness may also be related to sleep disruption from hot flushes and night sweats.
Fatigue is different from normal tiredness – it’s more extreme and unpredictable and doesn’t go away with rest or sleep. This may mean that you are unable to do everyday tasks and feel frustrated and as though things are beyond your control.
Research has found that regular physical activity such as walking can help improve fatigue, even if at first it feels difficult.
Lots of people have difficulty sleeping for different reasons, including hot flushes, night sweats and anxiety.
Avoiding alcohol, drinks containing caffeine and late night eating can help with disturbed sleep.
Some people find using relaxation or mindfulness apps, CBT or yoga help.
You may find some over-the-counter sleep aid remedies useful. Speak to a pharmacist for advice on what might be suitable for you.
If you have severe sleep issues speak to your treatment team or GP who may prescribe sleeping tablets for a short time.
There’s more information on sleep difficulties on the NHS website.
Changes to skin and hair
The menopause causes changes in the production of collagen, a protein found in the skin. Oestrogen is important for collagen production. It helps to keep the skin moist and elastic (stretchy).
Low levels of oestrogen lead to the skin becoming drier, thinner and less elastic.
Lack of oestrogen can also be linked with hair becoming thinner and dry.
These changes can affect how you feel about yourself. Trying the following may help:
- Eat a healthy diet
- Drink lots of water
- Wear high protection sunscreen
- Avoid very hot showers or baths
- Avoid scented soap
- Apply body lotion to help keep the skin moist
- Use a light hair conditioner regularly on your hair
- Use a dry shampoo to absorb moisture without drying out your hair
- Use a heat-protection spray when using heated appliances
Effects on memory and concentration
During or after cancer treatment some people find it difficult to concentrate, or feel more forgetful. This is known as cognitive impairment.
Many women who are menopausal also find it harder to remember and recall things as well as they did before.
Tiredness, anxiety and changes to your sleep pattern can also cause you to become forgetful and stop you feeling mentally sharp.
It can be difficult to be sure what is causing these memory problems and this can be hard to cope with when you are trying to get back to normal.
If you are concerned, talk to your GP or treatment team.
6. Work and menopausal symptoms
Work and breast cancer
Having menopausal symptoms can disrupt your performance at work. You may be less productive, more forgetful and tired.
It may help to talk to your manager, colleagues or human resources department (if you have one) about any issues you are facing, so they can make reasonable adjustments.
Practical tips that may help you at work include:
- Have a fan nearby or carry a hand-held one
- Have access to cold drinking water
- Wear lightweight, breathable clothing
- Take regular breaks, especially if you’re on your feet a lot
- If possible, change your working hours if you’re having disturbed sleep
- Set up alerts and reminders on your phone
7. Further support
Treatment for breast cancer can cause changes to how you feel. It may take some time for you to adjust to these changes and your menopausal symptoms will hopefully improve over time.
Many people find it helps to talk to someone who has been through the same experience as them.
Our Someone Like Me service - please see below - can put you in touch with someone who has had a diagnosis of breast cancer, so you can talk through your worries and share experiences over the phone or by email.
You can also visit our confidential online forum and join one of the ongoing discussions.
If you'd like any further information and support about breast cancer, or just want to talk things through, you can speak to one of our experts by calling our free helpline, below.