1. The menopause and breast cancer
2. What is the menopause?
3. What are the common menopausal symptoms?
4. What breast cancer treatments can cause menopausal symptoms?
5. Menopausal symptoms and contraception
6. Can an early menopause affect my fertility?
7. Managing menopausal symptoms
8. Vaginal dryness
9. Stress, anxiety and mood changes
10. Other effects of menopausal symptoms
11. Further support
Breast cancer treatments such as chemotherapy, hormone (endocrine) therapy or ovarian suppression (stopping the ovaries working either permanently or temporarily) 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 pre-menopausal 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 treatment (HRT) when they are diagnosed with breast cancer. HRT is given to women 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. This 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.
The menopause is the time when a woman stops having periods, and she’s no longer able to get pregnant. It happens when the ovaries stop releasing eggs. The ovaries are the main source of the hormone oestrogen, so when they stop working, there is a drop in the level of oestrogen in the body. This change disrupts periods and causes the symptoms associated with the menopause. These symptoms usually last over a period of time from several months to a number of years.
The menopause is a natural event for all women and usually occurs between the ages of 45 and 55 years, with 51 being the average age. However, if you have had treatment for breast cancer, this may result in an early menopause or menopausal symptoms.
You may also hear the term ‘peri-menopause’ or ‘peri-menopausal’. This refers to time leading up to menopause when a woman’s hormones may rise and fall, causing irregular periods. This may happen over months or years.
Some of the more common menopausal symptoms include:
- hot flushes
- night sweats
- vaginal dryness
- heart palpitations
- mood changes
- joint pain
- changes to skin and hair
You may put on weight, particularly around the waist. You may also have difficulty sleeping. More rarely, some women experience a crawling sensation under the skin, usually on the chest. You may become anxious and irritable or have problems with memory or concentration. The changes you notice in your body may be gradual, but for some women symptoms can start suddenly.
Hormone (endocrine) therapies
The hormone therapies tamoxifen, anastrozole (Arimidex), letrozole (Femara) and exemestane (Aromasin) can all cause menopausal symptoms.
Ovarian suppression involves stopping the ovaries from making oestrogen, which can cause menopausal symptoms.
The natural menopause is a gradual process, whereas ovarian suppression can bring on menopausal symptoms suddenly and they may be more intense.
Ovarian suppression might include:
- the hormone therapy goserelin
- surgery to remove the ovaries
- radiotherapy to the ovaries
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 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 year after your chemotherapy has finished.
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.
Generally, you should assume you could still get pregnant unless:
- you are under 40 and haven’t had a period for two years since treatment
- you are over 40 and haven’t had a period for at least a year since treatment
However, this varies for each person. If you are unsure about your fertility or menopausal status, talk to your specialist team or GP, who can discuss contraception where appropriate.
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.
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 about specialist menopause clinics where you can get further advice and information about coping with menopausal symptoms.
Hot flushes are the most commonly reported menopausal symptom caused by breast cancer treatment. The frequency of hot flushes can vary for each person, from a couple a day to a few every hour. They can range from a mild sensation of warming which just affects the face, to waves of heat throughout the body. Some women also experience drenching perspiration affecting the entire body. For some, hot flushes will fade over time and become less severe, but for others they can last for many years.
Marie talks about her experience of hot flushes
Many women also get flushes at night, which can lead to disturbed sleep and waking in a cold, damp bed and needing to change the bed linen. This can be very disruptive, especially if you share a bed. Disturbed sleep due to hot flushes can result in forgetfulness, irritability and a lack of concentration.
- keep a battery-operated or paper fan with you at all times
- wear layers so that you can remove clothing when a flush starts
- wear loose-fitting, cotton clothing
- use a silk pillowcase, a specially designed pillow that stays cool or a cooling scarf
- always keep a bottle of water with you and avoid caffeine, alcohol and spicy foods
- carry a water spray containing a fragrance of your choice
Non-hormonal prescription drugs for hot flushes
A number of prescription drugs have been shown to help relieve hot flushes and some women find these helpful. However, these drugs can have side effects so you may need to see if the benefits of taking them outweigh the drawbacks. Clinical trials of drug treatments for hot flushes are ongoing.
Studies have shown that some anti-depressant drugs can help reduce hot flushes for some women, although these benefits may wear off over time. For example, venlafaxine can be prescribed in a lower dose to help with hot flushes than when prescribed for depression, and so is unlikely to have an anti-depressant effect. Possible side effects include nausea (feeling sick), diarrhoea, sleepiness, loss of libido and dizziness. Some women also experience mood changes.
Other anti-depressant drugs, such as fluoxetine and paroxetine, are sometimes prescribed to help reduce hot flushes. Some studies suggest that these drugs may interfere with the way tamoxifen works. However, more recent research suggests this may not be the case. You can discuss this further with your breast care nurse or specialist.
Clonidine is a drug normally used to treat high blood pressure. It may also be used for managing hot flushes, and can be effective for some women. Clonidine can take a few weeks to work. Side effects include light-headedness, dry mouth, headaches, constipation and drowsiness.
Gabapentin and pregabalin are drugs usually used to treat chronic pain and epilepsy but they may also be helpful in reducing the severity of hot flushes. They can have side effects, including fatigue, sleep disturbance and anxiety. Slowly increasing the dosage over time may reduce the side effects.
Some of these drugs may interact with other drugs you might be taking, so check this with your specialist team.
You may need to try several drugs before you find one that helps you.
Hormone replacement therapy (HRT)
Although HRT is an effective treatment for menopausal symptoms, it’s not usually recommended for women who have had a diagnosis of breast cancer. This is because there’s uncertainty about whether HRT increases the risk of breast cancer coming back.
However, it may be recommended if you experience severe menopausal symptoms that significantly affect your quality of life, and if you haven’t responded to other treatments.
Your specialist team will discuss the risks and benefits of HRT and whether it may be appropriate for you.
Cognitive behavioural therapy (CBT)
Some studies have shown that a type of talking therapy called cognitive behavioural therapy (CBT) can help with menopausal symptoms, particularly hot flushes and night sweats. CBT focuses on problems and difficulties you are having in the ‘here and now’. Instead of exploring causes of your distress or symptoms in the past, it looks for ways to improve your state of mind in the present. You can ask for a referral for CBT with a trained counsellor, or there are various self-help books and apps available. CBT is also available privately.
Complementary therapies include a wide range of approaches that some women find helpful in relieving menopausal symptoms or improving their sense of wellbeing.
Compared to conventional drug treatments there is much less reliable evidence to show that complementary therapies work. It’s also important to consider the safety of some therapies, including whether any interact with the treatment you are on. Tell your breast care nurse or specialist about any complementary therapy or herbal supplement that you are considering using.
Complementary therapies include:
- herbal remedies
Manufacturers of a magnet that is attached to the underwear claim it can help reduce hot flushes. There is no evidence that these magnets work, but some women say they have found them useful.
Vaginal dryness is a very common menopausal symptom in women who have had treatment for breast cancer, and can be very distressing.
Low oestrogen levels can result in vaginal dryness and irritation, which can make sex and intimacy painful.
Vaginal dryness and irritation can also be caused by infection, so it’s best to visit your GP if you are experiencing problems to rule this out.
There are a number of treatments that can help with vaginal dryness. Vaginal moisturisers and lubricants can help, and can be used alone or in combination. These can be prescribed by a doctor, bought in a chemist or ordered online.
Pain or discomfort can reduce sexual feelings and desire. You may find it difficult talking about this with your partner or a close friend, let alone someone involved in your treatment. Vaginal dryness may not be a side effect mentioned by your treatment team but if you’re experiencing problems discuss this with your breast care nurse or GP.
Some women who have had a diagnosis of breast cancer find themselves feeling anxious a lot of the time, which may make menopausal symptoms worse. Sometimes anxiety can become so overwhelming it leads to panic attacks, causing further fear and worry.
Recognising that you are anxious is an important step, as sometimes feelings of anxiety can be linked to low mood and depression. You may feel a loss of control over everything that is happening to you and this can also affect how you are feeling.
Some women have difficulty concentrating and feel irritable. You may be short-tempered and experience extreme mood changes, from feeling positive and happy one day to miserable and low the next. This can be unexpected and without reason. These feelings tend to improve over time but for some women they can be overwhelming.
If you are feeling low or depressed, it may help to discuss how you are feeling with your breast care nurse or GP.
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, and can stop your mind from wandering.
Sex and intimacy
Being diagnosed with breast cancer can affect how you feel about sex and intimacy. People with breast cancer may lose interest in sex and intimacy for many reasons. It may be a result of the diagnosis itself, treatment or side effects, or concerns with body image. How you think and feel about your body may have changed since you were diagnosed with breast cancer. Body image and self-esteem play an important part in how we feel about our sexuality.
Menopausal symptoms such as hot flushes, night sweats and vaginal dryness as well as a decreased sex drive (libido) 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 specialist team, breast care nurse or GP as they may be able to help.
Some women experience bladder problems such as passing urine more frequently, developing urinary tract infections 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 bladder infection.
Pelvic floor exercises may help to improve your bladder control. You can read how to do these on the NHS Choices 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 GP or practice nurse can give you more information on achieving a healthy weight or 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 GP, specialist team or breast care nurse 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. You’ll find information on this in our booklet Osteoporosis and breast cancer treatment.
Fatigue (extreme tiredness)
Cancer-related fatigue is something that many women experience during or after their treatment.
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, can be 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 impossible.
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. Eating a healthy diet, drinking lots of water, wearing high protection sunscreen in the sun, avoiding very hot showers or baths and scented soap, and applying body lotion can all help keep the skin moist. Regularly applying conditioner and using an oil treatment on your hair may also help.
Effects on the brain
During or after cancer treatment some people find it difficult to concentrate, or feel more forgetful. This is known as cognitive impairment or ‘chemo brain’. 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 specialist team.
Being diagnosed with breast cancer can make you feel lonely and isolated.
Many people find it helps to talk to someone who has been through the same experience as them. Breast Cancer Now’s Someone Like Me service 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 would 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 on 0808 800 6000.