Managing menopausal symptoms

In this section you will learn more about menopausal symptoms that can result from breast cancer treatment, including ways to control them.

Hot flushes and sweats Back to top

These are the most common menopausal symptoms. Although the exact cause is unknown, body temperature control seems to be affected by falling oestrogen levels. 

What are they?

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 of the 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, 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.

What can I do about them?

There are several approaches that you may find helpful. Using a combination of approaches is often most successful at 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 to find out what things trigger flushes so you can try to avoid them. Even for women who don’t have obvious triggers for their flushes, keeping a record can be a helpful way of measuring if a treatment for flushes helps and by how much.

You may also want to try complementary therapies| . There is evidence from research studies that some of them can help reduce flushes in some women.

There are also a range of medicines that your doctor can prescribe, to help to reduce the severity and number of flushes and sweats:

Antidepressants such as paroxetine, fluoxetine and venlafaxine may reduce the number and severity of hot flushes by about half (50%) in some women. It generally takes from 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 treatment (HRT) can be prescribed if your symptoms are severe and nothing else helps. However, taking HRT after you have 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 that you are clear about 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 have had breast cancer.

Vaginal dryness Back to top

A low level of oestrogen in the body 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 of the products below is most suitable for you. Your treatment should be regularly reviewed by your doctor, and you should tell them about any new symptoms.

Some of the creams may damage condoms and diaphragms, so care should be taken to avoid pregnancy.

Non-hormonal creams

Replens MD ^® is a non-hormonal cream that you apply 2–3 times a week. The cream binds to the vaginal wall and helps to rehydrate cells. It boosts blood flow in the vagina.

Water-based lubricants such as Senselle ^® , KY-Jelly ^® , Astroglide ^® and Sylk ^® can help to reduce discomfort from vaginal dryness during sexual intercourse.

Hormone-based treatments

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). It’s normally used daily for two weeks, and then dosage is reduced to just 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 ^® are creams, or pessaries, that can reduce dryness and itching for a short time. They contain a small amount of oestrogen.

Estring ^® is a vaginal ring that is worn for three months. It slowly releases a small amount of oestrogen and may help to reduce dryness. 

Passing urine more often Back to top

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.

Difficulty sleeping Back to top

You may experience sleeplessness, due to hot flushes and sweats or anxiety. The following suggestions may help you to relax and sleep well, and can help you to feel more in control during the day:

• Have a lukewarm bath to relax before bedtime
• A warm herbal or milk drink before bed can help you to relax
• Wear nightwear that is made of absorbent lightweight cotton.
• If you can't sleep, don't just lie in bed - get up and read, listen to the radio or audio-books, or watch TV until you feel sleepy.
• Your GP can prescribe sleeping tablets for a short period of time; these may help to re-establish a sleep pattern.
• Techniques such as listening to relaxation tapes/CDs, doing relaxation exercises, visualisation, massage or meditation can help to reduce anxiety and sleeplessness.

Psychological effects Back to top

The psychological effects of menopausal symptoms can be hard to cope with when you already have to deal with the physical effects of cancer.

Some menopausal symptoms are very difficult to deal with. These include a lower sex drive, mood swings, lack of confidence and a loss of concentration and memory. You may feel emotional or anxious without really knowing why.

We have a list of helpful books and organisations| that provide support to women going through the menopause.