Breast cancer treatments such as chemotherapy, hormone (endocrine) therapy or ovarian ablation or suppression (stopping the ovaries working either permanently or temporarily) can cause menopausal symptoms during and beyond treatment.
The symptoms are often more intense than when the menopause occurs naturally. These can have a negative effect on everyday life – from not sleeping well due to hot flushes and night sweats; to a lack of confidence in general. Intimate relationships can also be affected.
Changes to hormone levels in the body and especially the loss of the female hormone oestrogen are the main cause of menopausal symptoms. Treatments for breast cancer are often given to reduce oestrogen levels, or block its action, resulting in menopausal symptoms. Around 70% of women will have menopausal symptoms during and after treatment for breast cancer.
Talking about menopausal symptoms can be difficult. Addressing any concerns you have is an important part of your treatment and recovery. In our booklet Menopausal symptoms and breast cancer you will find a prompt list to help you talk about your symptoms with a healthcare professional.
You can talk to your specialist team about helping to manage these symptoms. It’s also worth asking if there’s a specialist menopause clinic in your local area where you can get further advice and information about coping with menopausal symptoms.
Common menopausal symptoms
Some of the more common menopausal symptoms are mentioned below with some tips for dealing with them.
Hot flushes can vary for each person, from a couple per 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 most women, hot flushes will fade over time and become less severe, but some women can continue to experience them for months or even years.
Marie talks about her experience of hot flushes.
Many women also get flushes at night and/or night sweats, which can lead to disturbed sleep. This can be very disruptive. Disturbed sleep due to hot flushes can result in forgetfulness, irritability and a lack of concentration the following day.
- Keep a battery operated hand-held fan with you at all times.
- Wear layers so that you can remove clothing when a flush starts.
- Try a silk pillow case, a cool pillow known as a ‘chillow’ or a cooling scarf to keep you cool.
- Always keep a bottle of water with you and avoid caffeine, alcohol and spicy foods.
- Try to wear loose-fitting, cotton clothing.
- Keep a water spray with you containing a fragrance of your choice.
- Take regular exercise.
- Get to know what things trigger your hot flushes and try to avoid them.
There are a number of prescription drugs that have been shown to help relieve hot flushes and some women find these helpful. However, some of these drugs have side effects so you may need to see if the benefits of taking them outweigh the drawbacks. These drugs include low dose anti-depressant drugs like venlafaxine, fluoxetine and paroxetine. Sometimes other drugs like clonidine and gabapentin may also be used to control the hot flushes.
Hormone replacement treatment (HRT) is generally not offered to women with breast cancer because there’s uncertainty about whether HRT increases the risk of breast cancer coming back.
Stress, anxiety and mood changes
It is natural to feel anxious about your diagnosis and treatment. Some women become aware of their heartbeat racing (palpitations) and develop a sense of anxiety. Being anxious can sometimes make your menopausal symptoms worse. If you’re experiencing anxiety, there are various techniques and talking therapies designed to help:
- relaxation and meditation: to reduce stress and tension, relax the mind and body and help improve wellbeing
- distraction: shutting out negative thoughts
- counselling: one-to-one counselling takes place in a private and confidential setting. You will be able to explore feelings such as anger, anxiety and grief which can be related to your cancer diagnosis, making them easier to understand and cope with
- cognitive behavioural therapy (CBT): aims to help change negative patterns of thinking.
If you are feeling low or depressed, it may help to discuss how you are feeling with your breast care nurse or GP. You can find more information about stress, anxiety and depression in the NHS Choices Moodzone.
Intimacy, sex and breast cancer
Being diagnosed with breast cancer will almost certainly 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 and night sweats as well as a decreased sex drive (libido) can affect new and existing relationships and your sex life.
If you are experiencing any problems, it may help to talk to your breast care nurse, GP or practice nurse, as there are ways of helping you cope with these issues.
For more information, see our Your body, intimacy and sex booklet.
Some women experience bladder problems such as incontinence, passing urine more frequently and developing urinary tract infections during the menopause. If you have a burning pain when passing urine or find you are passing small amounts of urine frequently it is worth checking with your GP to see if you have a bladder infection. Pelvic floor exercises may help improve bladder control.
Putting on weight
Weight gain, especially around the waist, is common during both cancer treatment and the menopause. Your GP or practice nurse will be able to give you more information on achieving a healthy weight if needed or they can refer you to a dietician for further advice if necessary.
Breast Cancer Care has produced a DVD, Eat well, keep active after breast cancer to help people get back into activity and eat healthily after breast cancer treatment.
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 and tiredness
Cancer-related fatigue is something that many women experience at some point during or after their treatment. Feeling fatigued or constantly tired is another common symptom of menopause and can be a side effect of treatments for breast cancer. Fatigue is different from normal tiredness – it’s more extreme and unpredictable and doesn’t go away with rest or sleep.
These feelings may also be related to sleep disruption from hot flushes and night sweats. Research has found that gentle, regular exercise such as walking can help improve your feelings of fatigue, even if at first it feels impossible.
Changes to skin and hair
The menopause causes changes to the skin and hair due to lower levels of oestrogen. This may lead to the skin becoming dryer, thinner and less elastic, and can also be linked to hair becoming thin and dry.
Eating a healthy diet, drinking lots of water, using sunscreen and applying body lotion may help. Using an oil treatment and conditioner regularly can also improve the condition of your hair.
Effects on memory
Changes to your sleep pattern, tiredness and anxiety can cause you to become forgetful and stop you feeling on top of things. This can be difficult to cope with when you are trying to get back to normal but usually improves over time.
Some women may find complementary therapies help with relaxation and relieve hot flushes, although there is limited evidence to support their use.
Some women also find using herbal remedies and/or phytoestrogens helpful in reducing their menopausal symptoms. But because it’s currently uncertain what effect these may have on breast cells and the evidence on their effectiveness is limited and conflicting, you should check with your doctor or breast care nurse before taking any supplements.
The National Institute for Health and Clinical Excellence (NICE) is an independent organisation responsible for providing national guidance on promoting good health and preventing and treating ill health. NICE does not recommend soy (isoflavones), red clover, black cohosh or vitamin E for the treatment of menopausal symptoms in women with breast cancer.
For more information, see our Complementary therapies booklet.