Breast cancer and menopausal symptoms

Some breast cancer treatments may put you into an early menopause and cause menopausal symptoms. Hormone therapy can cause menopausal symptoms even in women whose periods stopped some years before they were diagnosed with breast cancer.

Doctors do not recommend taking hormone replacement therapy after breast cancer. This is because we know that HRT can increase the risk that the breast cancer will come back. It also increases the risk of developing another breast cancer. But some doctors will prescribe HRT, particularly if you are having very severe menopausal symptoms.

Symptoms you may have that are related to the menopause include

• Hot flushes and sweats
• Anxiety
• Depression
• Lowered sex drive (libido)
• Dry skin
• Dryness in the vagina
• Bone thinning over some years

HRT is the only way to completely get rid of menopausal symptoms. This is particularly true with mood changes and lowered sex drive. But there are ways of reducing other symptoms. Below, you can find out about ways of dealing with flushes, vaginal dryness and bone thinning when you can't take HRT.

To reduce the number or severity of flushes, you can try the following suggestions

• Cut out coffee, tea and nicotine
• Keep your room cool – use a fan if necessary
• Spray your face with a cool water atomiser
• Wear several layers of light clothing that you can easily take off or put back on
• Wear natural fibres such as silk or cotton instead of man made fabrics
• Cut down on alcohol
• Sip cold or iced drinks
• Have a lukewarm shower or bath instead of a hot one
• If you sweat a lot at night, put a towel on your bed so you can easily change if it gets wet
• If you are taking tamoxifen, changing the brand may reduce sweats, or taking half the dose in the morning and half in the evening
• Ask your doctor if you can try medicines to help

Low dose progesterone tablets have been shown to reduce the number of flushes. And to make them milder. Recent research has shown that some antidepressant drugs can help with hot flushes. You may be offered fluoxetine (Prozac) or paroxetine (Seroxat), but not if you are taking tamoxifen. Paroxetine may help reduce menopausal hot flushes by two thirds (so if you have 30 flushes a day, you could have as few as 10). But these tablets can take at least 3 to 4 weeks to work.

There are a number of other drugs that are sometimes offered to women with breast cancer, who have hot flushes. Your doctor should fully discuss with you their possible side effects before prescribing them. Low doses of an antidepressant called venlafaxine (Efexor) may be helpful. This can cause side effects, such as feeling sick, a dry mouth, and loss of appetite. A drug called clonidine (Catapres, Dixarit) may help with hot flushes, but again it takes a few weeks to work and may not help some women at all. It can cause constipation, skin problems and drowsiness. 

A drug called gabapentin is sometimes used to reduce hot flushes, but it can cause side effects such as diarrhoea, indigestion and nausea. Gabapentin is an anti epileptic drug that is also used for pain control. A drug called pregabalin (also used to control nerve pain or epilepsy) can reduce the number and severity of hot flushes for some women. It can cause side effects, such as dizziness, weight gain, sleepiness, coordination difficulties, trouble concentrating, and blurred or double vision in some women. But these side effects are usually mild. 

Tibolone (Livial) is a type of hormone replacement therapy (HRT) that does not contain oestrogen. It can help to reduce flushes and sweats and can also boost sex drive. But a large study has found that it increases the risk of breast cancer coming back. So it should not be used by women who have had breast cancer. It may also cause weight gain, fluid retention, dizziness, joint pains, and skin problems.

There is information about dealing with sweating in our section about coping physically with cancer.

If you have vaginal dryness you can try the following products to help provide moisture and lubrication.

• KY jelly
• A non hormonal moisturiser called Replens that you use 3 times a week
• Creams or pessaries containing oestrogen

Most specialists think that very little of the oestrogen in the creams and pessaries is absorbed. So it is unlikely to affect your breast cancer. But check with your specialist before you use these. There is more information about sex and cancer in the coping with cancer section of CancerHelp UK.

Any cancer treatment that leads to lower than normal oestrogen levels in women can increase the risk of bone thinning (osteoporosis). So you could be more at risk than average if you’ve had any of the following treatments.

• Chemotherapy that has caused an early menopause
• Hormone therapy with drugs called LHRH analogues (for example, Zoladex)
• Hormone therapy with a drugs called aromatase inhibitors (for example, anastrozole, exemestane or letrozole)
• Radiotherapy to your ovaries to stop them working
• Your ovaries removed when you were premenopausal

If your menopause has been brought on early, because of your treatment, or you are starting to take aromatase inhibitors or an LHRH analogue drug, then you should have a DEXA scan to check your bone density. If you've had your menopause and you are taking tamoxifen, you have less of a risk of bone problems. Exercise is the only way to build up your bones again. This has to be exercise that puts pressure on your bones (weight bearing exercise). Swimming does not help because you are supported by the water. Walking, cycling or exercise in the gym can all help. There is detailed information about osteoporosis risk and hormone therapy in the breast cancer questions section.

There is more information in our hormone symptoms section including information about the different symptoms and how to cope with them.