Sex life and fertility after treatment for breast cancer
How breast cancer and its treatment can affect your sex life
Breast cancer and its treatments and side effects may affect your sex life and how you think and feel about your body (body image).
Problems can happen as a result of the physical and emotional effects of cancer and its treatment. Things like feeling Tiredness tired, pain and menopausal symptoms such as vaginal dryness may affect your sex life. You may have a lower sex drive (low libido) or be adjusting to a change in how your body looks or feels.
Difficulties often slowly improve after treatment, but it may take longer. Some people may continue to have difficulties.
You may feel insecure and worry about your current or future relationships. If you have a partner, it can help to talk openly with them about your feelings. You may both need some time to adjust.
Let your doctor or nurse know if any difficulties with your sex life do not improve. There are ways to improve your sexual well-being and manage any problems. They may be able to reassure you or offer further help and support. If you feel uncomfortable talking to your doctor or nurse, you can call us for free on 0808 808 0000.
Some people may find it helpful to talk to a sex therapist. You can contact a therapist through the College of Sexual and Relationship Therapists.
We have more information about sex and cancer.
Fertility
Some breast cancer treatments may affect your ability to get pregnant. This is called your fertility.
Your periods may stop during treatment. If you are younger, they may start again after treatment has ended. But it may take several months for them to start again. If you are close to your natural menopause, chemotherapy can cause an early menopause.
It is important to talk to your cancer doctor about your fertility before treatment starts. Sometimes it may be possible to remove eggs from your ovaries before treatment. If you have a partner, it may be possible to fertilise the eggs with their sperm. The fertilised eggs (embryos) can be frozen and stored to use later. If you do not have a partner, you may be able to have your eggs frozen and stored.
Becoming infertile can be very hard to cope with, whether or not you already have children. You may find it helpful to talk about your feelings with a trained counsellor. If you need more specialist help, ask your cancer doctor or breast care nurse to arrange this for you.
Contraception
Your doctor will advise you not to get pregnant while having treatment and for some time afterwards. The drugs can affect your eggs. This may harm a developing baby. It is important to use effective contraception. You can talk about this with your doctor or nurse.
Your cancer doctor or nurse will advise you not to use contraception that contains hormones. This includes the pill or implants that release hormones. Your GP can give you advice about methods of contraception. These may include:
- coils (intra-uterine devices) that do not contain hormones
- barrier methods such as condoms
- diaphragms or caps.
Mirena® coil
The Mirena® coil works by releasing a small amount of a hormonal medicine into the womb. The medicine is called levonorgestrel. It is an artificial type of progesterone. Doctors are unsure how much of it reaches other parts of the body after it has been released into the womb.
Studies have tried to find out if the Mirena coil could cause cancers that depend on hormones to grow. The results have been mixed. But there is currently no strong evidence to show that the Mirena coil encourages these types of cancer to grow. Because it contains progesterone, it is not usually recommended for people who have had cancers that depend on hormones to grow. This includes breast cancer.
If you are concerned, you can talk to your GP or specialist about what contraception is best for you.
Pregnancy
Having a family can be an important part of life after cancer.
Doctors usually advise that you wait at least 2 years after cancer treatment before trying to get pregnant. This is usually because:
- for some cancers, the risk of the cancer coming back is higher in the first 2 years after diagnosis and treatment
- it gives you time to recover from treatment
- it gives your fertility time to recover
- if the cancer is ER positive, you will be able to have some hormonal therapy before trying to get pregnant.
Being pregnant raises your natural hormone levels, so it is important to talk to your specialist nurse if you are planning to get pregnant. But recent research has shown that pregnancy after breast cancer does not increase the risk of the cancer coming back. This is true even if the original cancer had hormone receptors (was ER positive). Your cancer doctor or specialist nurse can advise you on the risk of the cancer coming back and how safe pregnancy is in your situation.
Tamoxifen is usually prescribed for up to 10 years. Depending on your age when you start taking tamoxifen, this may be an issue if you want to get pregnant. It is important to talk about this with your cancer doctor. It may be possible to stop taking tamoxifen for a short time to try and get pregnant and have a baby. Tamoxifen can affect an unborn baby, so it is not safe to get pregnant while taking it. You must have stopped taking it for 3 months before trying to get pregnant. Your cancer doctor or specialist nurse can give you more information about this.
Talk to your cancer doctor before you stop taking any medicines.
We have more information about cancer and pregnancy.
Referral to a fertility clinic
If you are having difficulty getting pregnant, ask your cancer doctor, specialist nurse or GP to refer you to a fertility specialist. The fertility specialist will talk to you about possible options for you.
There are different ways of becoming a parent. There are different ways to become a parent, such as fertility treatment, surrogacy or adoption.
If you had eggs or an embryo frozen and stored before treatment, you may be able to have fertility treatment later on. This may result in a pregnancy. There are rules about fertility treatments, and these can be different across the UK. Your cancer doctor or fertility doctor can give you more information about this.
We have more information about fertility.
Early menopause or menopausal symptoms
Some treatments can cause an early or temporary menopause. Hormonal therapy can cause side effects that are the same as menopausal symptoms.
Doctors do not recommend hormone replacement therapy (HRT). This is because it contains oestrogen. This could encourage breast cancer cells to grow.
Early menopause can increase the risk of bone thinning (osteoporosis). We have more information about looking after your bones, including helpful tips on keeping them healthy.
A number of organisations, including the Daisy Network and Menopause and cancer, provide support to women going through the menopause. You can also visit our breast cancer forum to talk with people who have been affected by breast cancer, share your experience, and ask an expert your questions.
About our information
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References
Below is a sample of the sources used in our breast cancer information. If you would like more information about the sources we use, please contact us at cancerinformationteam@macmillan.org.uk
ESMO. Early breast cancer clinical practice guidelines for diagnosis, treatment and follow-up. 2019, Vol 30, pp1192–1220. Available from: https://www.esmo.org/guidelines/guidelines-by-topic/breast-cancer/early-breast-cancer [accessed 2023].
National Institute for Health and Care Excellence (NICE). Early and locally advanced breast cancer: diagnosis and management. 2018. Updated 2023. Available from: https://www.nice.org.uk/guidance/ng101 [accessed 2023].
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Reviewers
This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Dr Rebecca Roylance, Consultant Medical Oncologist and Professor Mike Dixon, Professor of Surgery and Consultant Breast Surgeon.
Our cancer information has been awarded the PIF TICK. Created by the Patient Information Forum, this quality mark shows we meet PIF’s 10 criteria for trustworthy health information.
The language we use
We want everyone affected by cancer to feel our information is written for them.
We want our information to be as clear as possible. To do this, we try to:
- use plain English
- explain medical words
- use short sentences
- use illustrations to explain text
- structure the information clearly
- make sure important points are clear.
We use gender-inclusive language and talk to our readers as ‘you’ so that everyone feels included. Where clinically necessary we use the terms ‘men’ and ‘women’ or ‘male’ and ‘female’. For example, we do so when talking about parts of the body or mentioning statistics or research about who is affected.
You can read more about how we produce our information here.
Date reviewed
Our cancer information meets the PIF TICK quality mark.
This means it is easy to use, up-to-date and based on the latest evidence. Learn more about how we produce our information.
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