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There are several approaches that may help to reduce menopausal symptoms. Choosing which are right for you will depend on your personal preferences, the possible risks and benefits of each approach, the type and severity of your symptoms, and what other treatments you are taking.
Your symptoms may include:
This is the most common menopausal symptom. Although the exact cause is unknown, body temperature control seems to be affected by falling oestrogen levels. Hot flushes can vary from a mild feeling of warmth in the face to more severe symptoms such as drenching night sweats that affect the whole body.
Hot flushes generally last for about 4–5 minutes. During a hot flush you may feel sudden warmth in your face, neck and chest, and you may become flushed and perspire. Some women feel their heart beating faster (palpitations) during a flush.
If you have flushes at night, these may affect your sleep. Night sweats can be particularly disruptive to your sleep pattern, especially if you need to change your night clothes and bedding.
It’s difficult to stop hot flushes and sweats, but their frequency or intensity can often be reduced.
There are several approaches that you may find helpful. Using a combination of approaches is often the most successful way of controlling or reducing flushes.
For some women, certain situations may bring on a hot flush. For example, you may notice that if you get too warm this can trigger a hot flush. Or a flush may be brought on by drinking tea, coffee or alcohol, or by eating spicy foods. Keeping a record of when you have flushes can help you find out what triggers them, so that you can try to avoid these triggers. Even for women who don’t have obvious triggers for their flushes, keeping a record can be a helpful way of measuring how much a treatment for flushes helps. You may also want to try one or more of the complementary therapies| we describe later in this fact sheet. There's evidence from research studies that some of these therapies can help reduce flushes in some women.
There are also a variety of medicines that your doctor can prescribe to help reduce the severity and frequency of your flushes and sweats:
Antidepressants such as venlafaxine, paroxetine and fluoxetine may reduce the frequency and severity of hot flushes by about 50% (half) in some women. It generally takes 1–4 weeks for antidepressants to reduce hot flushes. Side effects of antidepressants can include headaches, feeling sick|, reduced appetite|, a dry mouth| and constipation|.
Paroxetine and fluoxetine aren't recommended for women taking tamoxifen| as they may interfere with its effectiveness. However, venlafaxine doesn't interact with tamoxifen so can be taken with it.
Gabapentin (Neurontin®) is an anti-epilepsy drug that has been shown to be effective at reducing hot flush severity and frequency. Possible side effects include fatigue|, drowsiness and dizziness.
Clonidine (Catapres®, Dixarit®) is a medicine used to treat high blood pressure or migraines. It can be helpful in reducing hot flushes and sweats in some women. It can take four weeks to work. Side effects can include constipation, a dry mouth and drowsiness.
Hormone replacement therapy can be prescribed if your symptoms are severe and nothing else helps. However, taking HRT after you've had breast cancer| can increase the risk of the cancer coming back. Before taking a hormone-based treatment for menopausal symptoms, it’s important to talk this through with your cancer specialist to make sure you understand the possible risks and benefits.
Recent breast cancer treatment guidelines don’t recommend non-oestrogen types of HRT such as Tibolone (Livial®) and progestogens (megestrol acetate, norethisterone and medroxyprogesterone acetate) as treatments for menopausal symptoms in women who've had breast cancer.
Having a low level of oestrogen can cause vaginal dryness and itching. Some creams can be helpful when applied directly to the vagina (topical treatment).
Your doctor can tell you which product is most suitable for you. Your treatment should be regularly reviewed by your doctor, and you should tell them about any new symptoms.
Some creams may damage condoms and diaphragms, so you may need to use another form of contraception to avoid pregnancy.
Replens MD® is a non-hormonal cream that you apply 2–3 times a week. The cream binds to the vaginal wall and helps rehydrate cells. It boosts blood flow in the vagina.
Water-based lubricants such as Senselle®, KY-Jelly®, Astroglide® and Sylk® can help reduce discomfort from vaginal dryness during sex.
Some treatments contain a small amount of the hormone oestrogen. The long-term risks of using products containing oestrogen after breast cancer are unknown. There is a possibility that they could increase the risk of the cancer coming back, although this is uncertain. Topical oestrogen treatments may also affect the cells that line the womb.
Vagifem® is a tablet that you insert into the vagina (a pessary). You normally use it daily for two weeks, and then reduce the dosage to twice a week. A small research study has shown that Vagifem can increase the amount of oestrogen circulating in the body. Because of this risk, Vagifem may not be recommended for women who are taking aromatase inhibitors|, such as anastrozole (Arimidex®), exemestane (Aromasin®), or letrozole (Femara®). Your specialist or breast care nurse can give you further advice and information about this.
Ovestin® and Ortho-Gynest® can reduce dryness and itching for a short time. They're available as creams and pessaries. They contain a small amount of oestrogen.
Estring® is a vaginal ring that's worn for three months. It slowly releases a small amount of oestrogen and may help reduce dryness.
You may pass urine more often, have some urine leakage or be more prone to urinary infections.
It is important to drink enough fluid (at least 2–3 pints/1.5 litres) each day to keep your bladder healthy. If you don’t drink enough, your urine will become concentrated and irritate the bladder. You will also be more likely to develop urinary infections.
If you have problems with urine leakage, doing regular pelvic floor exercises (also called Kegel exercises) can help. These exercises strengthen the muscles that hold urine in the bladder. Your nurse or doctor can explain how to do these exercises or you can order an instruction leaflet from the Bladder and Bowel Foundation|.
Speak to your doctor if you develop symptoms of a urinary infection such as pain or discomfort when passing urine, cloudy looking urine or urine that smells bad.
You may experience sleeplessness because of hot flushes and sweats or anxiety. The following suggestions may help you to relax and sleep well, and they can also help you feel more in control during the day:
Your GP can prescribe sleeping tablets for a short period of time – these may help you re-establish a sleep pattern.
Techniques such as relaxation exercises, visualisation, massage, meditation or listening to relaxation tapes/CDs can help reduce anxiety and sleeplessness.
The psychological effects of menopausal symptoms can be hard to cope with when you already have to deal with cancer.
These effects can include a lower sex drive|, mood swings, a lack of confidence, and a loss of concentration and memory. At times you may feel very emotional or anxious|.
Many women find it helpful to talk through their feelings with family and friends or their doctor or nurse. A number of organisations| provide support to women going through the menopause. Some women may find counselling helpful. Your doctor or nurse can give you more advice.
For answers, support or just a chat, call the Macmillan Support Line free (Monday to Friday, 9am-8pm)
If you have any questions about cancer, need support or just want someone to talk to, ask Macmillan.