Managing menopausal symptoms

There are different ways to reduce menopausal symptoms. Hot flushes and sweats are a common symptom. They can last a few minutes and affect your sleep. Some women feel their heart beating faster during a flush.

Knowing triggers for a hot flush helps you to avoid them, for example drinking tea, coffee or alcohol, or eating spicy food. Wearing natural fabrics, keeping cool and using controlled breathing techniques or yoga can also help. Doctors sometimes prescribe antidepressants and other drugs to reduce hot flushes. They don’t usually recommend HRT in women with breast cancer.

Menopause can cause vaginal dryness and itching. This can make having sex uncomfortable. There are different creams and lubricants that can help with this. Sometimes doctors prescribe a cream containing a small amount of oestrogen.

You may pass urine more often. Drinking plenty of fluids and doing pelvic floor exercises can help.

You may have trouble remembering things and have mood swings. You may also be less interested in sex. Your nurse or doctor can give you advice on what may help.

Managing symptoms

There are several things that may help to reduce menopausal symptoms. Choosing which ones 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
  • what other treatments you are taking.


Hot flushes and sweats

This is the most common menopausal symptom. Although the exact cause is unknown, falling oestrogen levels seem to affect body temperature control. Hot flushes can vary from a slight 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 four to five minutes. During a hot flush you may feel sudden warmth in your face, neck and chest, you may become flushed and you may perspire. Some women feel their heart beating faster (palpitations) during a flush.

Flushes at night (night sweats) can disrupt your sleep pattern, especially if you need to change your night clothes and bedding.

It’s difficult to completely stop hot flushes and sweats, but you can usually reduce their intensity and how often they happen. It’s often best to try a combination of approaches.

Be aware of triggers

Certain situations may bring on (trigger) a hot flush. For example, getting too warm, drinking tea, coffee or alcohol, or eating spicy foods can often bring on flushing. Keep a record of when you have flushes to help you find out what triggers them. You can then try to avoid these triggers.

Even if you don’t have obvious triggers, keeping a record can help to measure how well treatment for hot flushes is helping.

Practical tips

There’s lots of practical advice available to help women cope with hot flushes. Here are a few tips:

  • Wear natural fabrics, such as cotton. Dress in layers, so you can remove clothes as needed.
  • Use cotton sheets and have layers of bedding that you can easily take off during the night.
  • Keep the room temperature cool or use a fan.
  • Have cold drinks rather than hot ones.
  • Cut down on the amount of alcohol you drink.
  • If you smoke, cut down or stop.
  • Losing weight can help to reduce flushing.
  • Try complementary therapies, such as controlled breathing, yoga or acupuncture.

Medicines

There are different medicines that your doctor can prescribe to help reduce the severity and frequency of your hot flushes and sweats:

Antidepressants

Antidepressants such as venlafaxine, paroxetine, fluoxetine mirtazapine and citalopram can reduce the frequency and severity of hot flushes in some women. It generally takes 1–4 weeks for antidepressants to reduce hot flushes. Side effects of antidepressants can include headaches, feeling sick, loss of appetite, a dry mouth and constipation. Some antidepressants can improve or interfere with sleep.

Some antidepressants aren’t recommended for women taking tamoxifen, as they may make it less effective. However, others don’t affect tamoxifen so can be taken with it. Your doctor can give you more advice.

Gabapentin (Neurontin®)

Gabapentin is an anti-epilepsy drug that has been shown to help with the severity and frequency of hot flushes. Possible side effects include feeling very tired, drowsiness and dizziness.

Clonidine (Catapres®, Dixarit®)

Clonidine is a drug used to treat high blood pressure or migraines and can help reduce hot flushes and sweats in some women. It can take four weeks to work. Side effects include constipation, a dry mouth and drowsiness.

Hormone treatments

Progestogens

Progestogens are manmade (synthetic) progesterone. They are given in low doses and can be very effective at reducing hot flushes. Two commonly used progestogens are:

  • megestrol acetate – taken daily as a tablet
  • medroxyprogesterone acetate –given as an injection every six weeks.

Side effects are uncommon but can include a small amount of vaginal bleeding (spotting) and weight gain.

Hormone replacement treatment (HRT)

HRT replaces the hormones (oestrogen and progesterone) that are no longer being produced by the ovaries. It can relieve symptoms such as hot flushes.

However, because HRT contains oestrogen it is not normally recommended after breast cancer treatment. This is because the oestrogen may increase the risk of the cancer coming back. There are types of HRT that do not contain oestrogen, such as Tibolone (Livial®). However, breast cancer guidelines do not recommend these either. Research has shown that both HRT and Tibolone can slightly increase the risk of breast cancer returning.

If a woman’s symptoms are severe and nothing else helps, HRT is sometimes prescribed, particularly if the breast cancer is not hormone sensitive. Before prescribing HRT your cancer specialist will talk to you about the possible risks as well as the benefits.


Vaginal dryness

A low level of oestrogen in the body can cause vaginal dryness and itching. This can make penetrative sex uncomfortable or painful.

Creams can help hydrate the vagina and/or provide lubrication. They are usually applied directly to the vagina (topical treatment).

Your doctor can tell you which product is most suitable for you. They should also review your treatment, 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.

Vaginal creams and lubricants

Replens MD® is a cream that binds to the wall of the vagina and helps rehydrate cells and make the vagina less dry. Hyalofemme® is another cream that helps to hydrate the cells giving a moisturising effect. Both creams are applied every two or three days.

Water-based lubricants such as Senselle®, KY-Jelly®, Astroglide® and Sylk® can help reduce discomfort from vaginal dryness during penetrative sex. Not all water-based products are the same and some can cause skin irritation. You may need to try a few different ones until you find one that suits you.

Hormone-based vaginal treatments

Some vaginal treatments contain a small amount of oestrogen. The long-term risks of using these treatments after breast cancer are unknown, but they are likely to be small. Your breast specialist may prescribe these treatments for short periods of time, and will talk to you about the possible risks and benefits in your situation.

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. Vagifem can increase the amount of oestrogen circulating in the body by a small amount, particularly in the first few weeks. Your breast 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. Very little oestrogen is absorbed into the body from Estring.

Other treatments

Gels that contain a small amount of anaesthetic can help to reduce pain after intercourse. Your doctor or breast care nurse can give you more information.


Loss of interest in sex

Losing interest in sex can happen for lots of reasons. It can be a symptom of the menopause but can also happen if you are tired, stressed or worried as a result of coping with the cancer and its treatments. Other menopausal symptoms such as hot flushes and vaginal dryness can also reduce your interest in sex.

Treating the cause may help to improve your sex life. Talk to your doctor or specialist nurse if you are having sexual problems as there may be treatments that can help, or they may be able to refer you to a sex therapist or counsellor.


Urinary problems

Oestrogen helps to maintain the health of the tube that drains urine from the bladder (urethra) and the pelvic floor muscles (that surround the base of the bladder and the urethra). When there is less oestrogen in the body, the urethra may become less elastic and the pelvic floor muscles may become weak. This can lead to urinary problems, such as:

  • urine infections
  • urine leakage (incontinence).

You may feel embarrassed and find it difficult to talk about these symptoms with your doctor or specialist nurse. However, they will have helped lots of women with these problems and should be able to help you.

Some hormone-based vaginal creams, such as Vagifem and Estring, may help to improve urinary problems. Talk to your doctor or specialist nurse.

Urine infection

Symptoms of a urine infection include:

  • cloudy or smelly urine
  • the need to pass urine more frequently than usual
  • pain or burning when passing urine
  • passing urine more often
  • a high temperature, fever and chills.

Tell your doctor if you develop any of these symptoms. You may need antibiotics to get rid of an infection.

To help reduce your risk of developing urine infections it is important to drink plenty of fluid each day. Try to drink at least two to three pints or one and a half litres. It can also help to empty your bladder before and after sex.

Incontinence

This can be a menopausal symptom, but can also happen for other reasons, for example if you have a urine infection. Talk to your doctor or specialist nurse if you have any incontinence as they may be able to help you. Treatments include tablets and sometimes surgery.

If you have problems with incontinence, it can help to do regular pelvic floor exercises (Kegel exercises). These exercises strengthen the muscles that hold urine in the bladder. Your nurse or doctor can explain how to do these exercises.

There are lots of different pads or panty liners you can use. Try to avoid those with a scent because they can irritate the skin and make symptoms worse.


Difficulty sleeping

You may have difficulty sleeping because of hot flushes, sweats or anxiety. The following suggestions may help you to relax and sleep well:

  • A warm drink, brushing your teeth or reading in bed for a while can let your brain know that it’s time to sleep.
  • Avoid drinks that contain caffeine, such as coffee, cola and tea, during the late afternoon and evening.
  • Sleep for the right amount of time without oversleeping – too much time in bed can affect the quality of your sleep.
  • Try to go to bed and wake up at the same time each day.
  • Get out of bed if you can’t sleep, and try reading, or listening to some soothing music. Wait until you feel tired again, and then go back to bed.
  • Do some light exercise during the day so that you feel more tired in the evening.
  • Breathing exercises and relaxation techniques, or listening to relaxation CDs, tapes or podcasts, can help reduce anxiety and sleeplessness.

Talk to your doctor or specialist nurse if you are having lots of difficulty trying to sleep. They may be able to suggest other things to help or prescribe a short course of sleeping tablets to help you get back into a sleep pattern.


Psychological effects

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

These effects can include mood swings, a lack of confidence and a loss of concentration and memory. At times you may feel very emotional or anxious.

You may find it helpful to:

  • do some relaxation exercises
  • get enough rest and sleep
  • do some gentle, regular exercise, such as walking, dancing or swimming
  • eat a well-balanced diet and cut down on alcohol.

Many women find it helpful to talk through their feelings with family and friends, or their doctor or breast care nurse. A number of organisations provide support to women going through the menopause. Some women may find counselling helpful. Your doctor or breast care nurse can give you more advice.

Back to Menopausal symptoms

What are menopausal symptoms?

Some breast cancer treatments may cause an early or temporary menopause, or side effects similar to menopausal symptoms.