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Macmillan and Cancerbackup merged in 2008. Together we provide free, high quality information for people affected by cancer through our publications, website and phone service. Find out more|.
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Treatment for breast cancer| may affect the way your ovaries work. As a result you may start your menopause earlier than expected, or have menopausal symptoms due to the treatment itself.
You can watch our video about Diane's experiences of menopausal symptoms after treatment for breast cancer|.
Surgery|, radiotherapy|, chemotherapy| and hormonal therapy| may be used alone, or in combination, to treat breast cancer. Some of these treatments can affect the way the ovaries work.
The menopause happens because the ovaries stop producing the hormones oestrogen and progesterone. Women naturally stop having regular periods, usually at some time between their mid-40s and mid-50s.
Women who have had chemotherapy close to the age of natural menopause (around 50) may go into the menopause abruptly. Younger women in their thirties may find that their periods stop for a while and then come back again. However, they may then go on to have an earlier menopause than usual. Women taking tamoxifen| or hormonal drugs called aromatase inhibitors|, such as anastrozole| (Arimidex®), letrozole| (Femara®) and exemestane| (Aromasin®) may have side effects that are similar to menopausal symptoms.
Coping with early menopause or menopausal symptoms when you’re already dealing with cancer can be very difficult. You may have other troublesome treatment side effects to cope with too. There are different approaches that may help you to cope or to reduce menopausal symptoms. Choosing the right approach for you will depend on different factors and your preferences. This includes the possible risks and benefits of each approach, the type and severity of your symptoms and on other treatments that you may be taking.
You may have one or more of the following symptoms, which can range from mild to more severe. Our section on breast cancer and menopausal symptoms| has more detailed information.
This is the most common menopausal symptom. Hot flushes can vary from a mild feeling of warmth in the face to a drenching night sweat. Flushes and night sweats can be particularly disruptive to your sleep pattern.
It’s difficult to stop hot flushes and sweats, but their frequency or intensity can often be reduced. Using a combination of approaches is often most successful at controlling or reducing flushes. Getting too warm, drinking tea, coffee, alcohol, or eating certain foods may bring on a hot flush. Keep a record of when you have flushes to find out what things trigger them, so you can try to avoid them.
Low doses of antidepressants such as paroxetine, fluoxetine and venlafaxine may reduce the number and severity of hot flushes by about half (50%) in some women. 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 they can be taken together.
An anti-epilepsy drug called gabapentin has also been shown to be effective at reducing the severity and frequency of hot flushes.
Megestrol acetate is also effective in treating hot flushes, but some doctors have concerns about using it because it contains progestogen, which is similar to the female hormone progesterone.
Clonidine is a medicine used to treat high blood pressure or migraines which may help in reducing hot flushes and sweats in some but not all women.
Hormone replacement therapy (HRT) is not recommended after breast cancer because it increases the risk of it coming back or of getting another breast cancer. Tibolone, a different type of HRT, should also be avoided. Athough it doesn’t contain oestrogen, it increases the risk of breast cancer coming back.
Some doctors may prescribe HRT if a woman’s symptoms are very severe and nothing else helps. It’s important to talk this through with your cancer specialist to make sure that you are clear about the possible risks and benefits.
There are different complementary therapies| that may help you to control hot flushes. Some of these have been researched, but for others the evidence is only anecdotal (based on personal accounts rather than facts). There is evidence from research studies that some complementary therapies can help reduce flushes in some women.
Acupuncture| involves putting sterile needles through the skin at specific points in the body. There’s some evidence that it may help to reduce the number and severity of hot flushes. Hypnosis may help to reduce the length and severity of hot flushes, but it’s unlikely to be available on the NHS.
Some trials have shown that using a slow controlled breathing technique, called paced respiration, can be an effective way of managing flushes. There’s also a yoga breathing technique, known as the ‘cooling breath’ or sheetali, that can help to reduce your body temperature.
Evening primrose oil is expensive and there’s no scientific evidence that it works for reducing menopausal symptoms, although it’s used by some women. There isn’t good evidence that Vitamin E helps to reduce menopausal symptoms and its use isn’t recommended. Plant oestrogens (phytoestrogens) can have a weak oestrogen-like effect, but there’s no evidence they improve menopausal symptoms. There is also concern that they may increase the risk of breast cancer coming back. Recent breast cancer treatment guidelines recommend that women who have had breast cancer don’t take plant oestrogens, such as black cohosh or red clover to treat menopausal symptoms.
Homeopathy uses tiny amounts of substances that would normally produce the symptoms being treated. Although it may be used by some women there’s no scientific proof that this works.
Different creams can help this problem. Replens MD® is a non-hormonal cream that you apply 2–3 times a week. 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 sex.
There are also some treatments that contain a small amount of oestrogen:
The long-term risks of using products containing oestrogen after breast cancer aren’t known. However, many breast specialists think that very little of the oestrogen in the creams and pessaries is absorbed by the body. If they’re prescribed for you they should be used in the lowest possible dose.
It’s important to talk to your specialist or breast care nurse before you use any products containing oestrogen.
You may pass urine more often, have some urine leakage or be more prone to urinary infections. It’s 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 to you how to do these exercises or you can order an instruction leaflet from the Bladder and Bowel Foundation|.
Vaginal treatments containing low doses of oestrogen can improve urinary problems and reduce urinary infections. Speak to your doctor if you develop symptoms of a urinary infection such as:
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:
Some women find a special pillow called a Chillow®, which acts as a cooling pad, helps them to sleep better.
Techniques such as listening to relaxation tapes/CDs/podcasts, relaxation exercises, visualisation, massage or meditation can help to reduce anxiety and sleeplessness. Your GP can prescribe sleeping tablets for a short period of time to help re-establish a sleep pattern.
The psychological effects of menopausal symptoms can be hard to cope with when you already have to deal with the physical effects of cancer. Psychological effects can 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. A number of organisations, including The Daisy Network|, provide support to women going through the menopause. Many women find it helpful to talk through their feelings with their doctor or nurse, or with family and friends. You may also find it helps to talk things through with a professional counsellor.
Becoming infertile| can be very hard for some women to live with, whether or not they already have children. Fertility is a very important part of many people’s lives, and not being able to have children can seem especially hard when you already have to cope with cancer.
Having your ovaries removed or having radiotherapy to stop the ovaries from working results in permanent infertility. If you have your ovaries removed you will have an immediate menopause. After radiotherapy to the ovaries it may take a few months for your periods to stop permanently.
Depending on your age, other treatments, such as chemotherapy and hormonal therapy, may cause a temporary or permanent menopause.
Some women find it helpful to talk through their feelings and your doctor can refer you to a counsellor if you need more specialised help. There are also organisations that offer support to women with fertility problems.
Our section on Cancer and fertility for women| has more information.
Menopause, particularly if it occurs early, may cause other effects on the body, such as thinning of the bones (osteoporosis) and heart problems. These effects develop at different rates in different people. Their tendency to develop is, at least partly, passed on from your parents (genetically determined). We have more information about what you can do to help look after your what you can do to help look after your heart and bones after breast cancer treatment.
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.