Menopausal symptoms and breast cancer

Many women have menopausal symptoms because of their breast cancer treatment.

Some treatments may cause an early menopause in women who have not already been through the menopause naturally (premenopausal women). This can lead to the symptoms described below. 

Some treatments will not cause an early menopause but may cause the symptoms associated with it.

You may have already been through the menopause, but having breast cancer treatment can cause you to have symptoms again.

You may be on hormone replacement therapy (HRT) when you 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. Stopping HRT can cause menopausal symptoms to return.

Some of the most common menopausal symptoms include:

• Hot flushes (also known as hot flashes)
• Night sweats
• Vaginal dryness and soreness
• Urinary tract infections (UTIs)
• Changes to how you experience orgasm
• Changes to sex drive
• Heart palpitations
• Mood changes
• Joint pain
• Skin and hair changes
• Weight gain, particularly around the waist
• Difficulty sleeping
• Memory and concentration problems
• Feeling anxious or irritable
• A crawling feeling under the skin

The changes in your body may be gradual, but often symptoms can start suddenly.

Hormone (endocrine) therapies

The hormone therapies tamoxifen, anastrozole, letrozole and exemestane can all cause menopausal symptoms.

Find out more about hormone therapies.

Ovarian suppression

Ovarian suppression describes treatments that stop the ovaries from making oestrogen, either temporarily or permanently. Ovarian suppression may also be called ovarian function suppression or OFS. 

Ovarian suppression is used:

• As part of treatment for breast cancer in premenopausal women
• To protect the ovaries during chemotherapy

Ovarian suppression can be carried out using:

• Hormone therapy drugs, such as goserelin, leuprorelin or triptorelin (usually monthly or 3 monthly injections) 
• Surgery to remove the ovaries (oophorectomy)

The natural menopause is a gradual process. Ovarian suppression can bring on menopausal symptoms suddenly, and they may be more intense.

Find out more about ovarian suppression.

Chemotherapy

If you have not yet reached the menopause, chemotherapy may cause your periods to stop or become irregular. This is because chemotherapy affects the ovaries, which produce oestrogen. 

This may cause an earlier, more sudden menopause. Symptoms are often more intense than when the menopause happens naturally.

You may stop having periods during chemotherapy, although this may be temporary. In this case, menopausal symptoms will improve when your periods return. This might be several months or years after your treatment has finished. 

Women aged around 40 and above are less likely to have their periods return after completing chemotherapy than women under 40. This means the menopausal symptoms may continue. 

Find out more about chemotherapy.

Even if you stop having periods and start having menopausal symptoms, you may still be fertile and could become pregnant.

You may also still be fertile even if you’re going through the menopause, as your ovaries might not have stopped working completely.

If you’re not sure about your fertility or whether you have been through the menopause, talk to your treatment team or GP.

Your treatment team may suggest having blood tests to check if you’re premenopausal or postmenopausal. However, this isn’t suitable or accurate for everyone and will depend on what treatment you’re having and where you are in your treatment.

Having an early menopause may mean coming to terms with the possibility of no longer being able to get pregnant. This can be very difficult to cope with, especially if you’re considering having children.

Menopausal symptoms can have a big impact on your quality of life. Your treatment team should let you know how your treatment may impact your menopause or menopausal symptoms.

How you decide 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.

If you’re struggling to manage your menopausal symptoms, you may be able to get information and support from a specialist menopause clinic. Ask your treatment team or GP about this.

Hot flushes and night sweats

Hot flushes, sometimes called vasomotor symptoms (VMS) or hot flashes, are the most commonly reported menopausal symptom caused by breast cancer treatment.

Vaginal and bladder problems

Genitourinary syndrome of menopause (GSM) refers to vaginal and bladder symptoms you may have because of the menopause.

Vaginal dryness

Vaginal dryness is a common and often very distressing menopausal symptom.

Some treatments affect the level of oestrogen in your body. Reducing the levels of oestrogen or blocking its action can cause vaginal changes.  

Symptoms of vaginal dryness can include:

• Itching or irritation
• Burning
• Pain
• Bleeding
• Urinary tract infections (UTIs)
  

The symptoms of vaginal dryness can get worse if they’re not treated, so it’s important to speak to your GP or treatment team.

Vaginal dryness and irritation can also be caused by infection, so it’s best to see your GP to rule this out.

Vaginal moisturisers and lubricants can help with vaginal dryness. You may be able to get these on prescription from your GP or treatment team, or you can buy them from a pharmacy.

You may not find a product that suits you straight away so it’s worth trying different products.

If you still have vaginal dryness and cannot find a product that suits you, you can ask your GP or treatment team if there are other options available.

You can read more about treatments for vaginal dryness on our sex and the effects of breast cancer treatment page.

Intimacy, sex and breast cancer

Menopausal symptoms such as hot flushes, night sweats, vaginal dryness and loss of sexual desire can affect sex and intimacy.

It may feel difficult or embarrassing talking about sex and intimacy. But it can help to discuss it with your treatment team or GP as they may be able to help.

Bladder problems

Bladder problems can include peeing more often, developing a urinary tract infection (UTI) and sometimes incontinence.

If you have a burning pain when peeing or are passing small amounts of urine often, 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.

Your treatment team may be able to refer you to a specialist pelvic floor physiotherapist.

Weight changes

Menopause and treatments for breast cancer can cause weight gain, particularly around the tummy area. 

Your treatment team or GP can give you more information on achieving a healthy weight. They can also refer you to a dietitian for further advice if necessary.

Find out more about healthy eating after breast cancer treatment.

Joint and muscle pain

Joint and muscle pain is a common menopausal symptom. It’s also a side effect of some breast cancer treatments, most commonly hormone therapies known as aromatase inhibitors. 

The pain can be mild and temporary for some people and more long term and severe for others.

You may feel pain in your hands, wrists and knees, but it can affect other joints too, such as your hips and shoulders. You might have stiffness in your joints, which can be worse first thing in the morning.

If joint or muscle pain becomes unmanageable and affects your daily activities, tell your treatment team or GP. They may suggest ways to manage your symptoms or refer you to a physiotherapist.

If you’re taking an aromatase inhibitor, your treatment team may suggest changing to a different hormone therapy to see if that suits you better.

Find out more about joint and muscle pain.

Risk of osteoporosis

Osteoporosis is a condition where your bones lose their strength and are more likely to break. 

Going through the menopause, either naturally or due to breast cancer treatments, increases the risk of developing osteoporosis.

Some breast cancer treatments also increase the risk of osteoporosis.

Your treatment team or GP may arrange for you to have a DEXA (dual energy x-ray absorptiometry) scan to check your bone strength if:

• Your breast cancer treatment caused an early menopause
• You’re starting ovarian suppression
• You’re going to be taking an aromatase inhibitor

If you’re worried about osteoporosis, talk to your treatment team or GP.

Extreme tiredness (fatigue)

Fatigue is extreme tiredness or exhaustion that doesn’t go away with rest or sleep. 

It’s a common symptom of the menopause and can also be a side effect of treatments for breast cancer. 

Feelings of tiredness may also be related to sleep disruption from hot flushes, night sweats or the emotional impact of your diagnosis.

Regular physical activity such as walking can help improve fatigue, even if at first it feels difficult.

Find out more about managing fatigue.

Difficulty sleeping

Menopausal symptoms such as hot flushes, night sweats, joint pains and anxiety can make sleeping more difficult. 

Your sleep may be affected in different ways. You may have difficulty falling asleep, wake often throughout the night, have restless legs or have poor quality sleep. 

Find out more about trouble sleeping, including things you can do to improve your sleep.

Changes to skin and hair

Oestrogen is important for producing collagen, which helps to keep the skin moist and elastic. 

Lower levels of oestrogen can lead to the skin becoming drier, less plump and less firm. It can also cause the skin to be more prone to damage from the sun. 

Some people have spots or acne because of the menopause. 

A lower level of oestrogen can also cause hair to thin and become drier.

The following skincare tips may help:

• Eat a healthy balanced diet
• Keep hydrated by drinking water
• Wear high protection sunscreen
• Avoid very hot showers or baths
• Avoid scented body products if your skin is dry, sensitive or prone to rashes
• Apply body lotion regularly to help keep the skin moisturised

Effects on memory and concentration

You may find it difficult to concentrate or feel more forgetful. This is called cognitive impairment, but you may hear it called “brain fog”. 

The menopause causes lower levels of oestrogen, which can affect memory and concentration. You may have:

• Short-term memory loss
• Difficulty concentrating or thinking clearly
• Difficulty doing more than one thing at a time
• Reduced energy levels, such as feeling tired (fatigue) or lacking in energy

You may also:

• Be unable to put thoughts into action
• Be less organised than usual
• Have trouble finding the right words or finishing sentences

Talk to your treatment team or GP if you have these symptoms. They can assess you and provide support to help manage your symptoms.

Tiredness, anxiety and sleep disturbance can also cause you to become forgetful and stop you feeling mentally “sharp”. Having good sleep, eating a healthy balanced diet, keeping hydrated and regular physical activity can all help with symptoms of brain fog. 

Find out more about cognitive impairment.

Stress, anxiety and mood changes

Mood changes such as anxiety and depression are common symptoms of the menopause. It’s also normal to feel anxious or stressed after a diagnosis of breast cancer. 

Stress and anxiety can make you feel nervous, worried and tense. Sometimes feelings of anxiety can be linked to low mood and depression. 

You can talk through your feelings with your treatment team or GP. They can refer you to more specialist psychological support or talking therapies.

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.

Find out more about coping emotionally.

Other less common symptoms

Other less common symptoms of the menopause may include:

• Headaches or migraines
• Pins and needles in hands or feet
• Restless legs
• Dizziness (vertigo)
• Feeling faint or dizzy
• Nail changes such as nails feeling dry and brittle
• Eye changes
• Dry mouth
• Feeling cold or cold flushes

Speak to your GP or treatment team if you have any of these symptoms and they’re affecting your daily living. 

You may be worried about the effect of your menopausal symptoms on your employment.

It can be difficult for your employer to know how to support you and understand any side effects you may have from treatment.

If you have breast cancer, your employer has to make reasonable adjustments to help you continue to work or return to work. Your employment rights are protected under the Equality Act 2010.

Talking to your manager or human resources department (if you have one) could help them be more supportive and to make reasonable adjustments.

Practical tips that may help you at work include:

• Consider a phased return if you stopped working during your treatment for breast cancer
• Have a fan nearby or carry a hand-held one
• Have access to cold drinking water
• Wear lightweight, breathable clothing
• Take regular breaks to help with your energy levels and concentration
• If possible, consider changing your working hours if you’re having disturbed sleep (this could be temporary)
• Set up alerts and reminders on your phone if you have difficulty remembering things

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.

If you find you’re unable to cope, talk to your treatment team or GP. They may be able to refer you to a specialist menopause clinic where you can get further advice and support about managing your menopausal symptoms. They may also be able to refer you to a counsellor or therapist who can help with emotional support.

Our Someone Like Me service – see below – can put you in touch with someone who has had a diagnosis of breast cancer. 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.