About menopausal symptoms and cancer treatment

Some cancer treatments can affect the way the ovaries work. This can cause an early menopause for some women.

Before menopause, the ovaries produce the hormones oestrogen and progesterone. These control a woman’s monthly cycle (periods). During menopause, periods gradually stop as the ovaries stop producing these hormones. For most women, this usually happens naturally between the ages of 45 and 55.

Different cancer treatments can cause an early menopause. These include:

Hormonal treatments for breast cancer may also cause menopausal symptoms or a temporary menopause.

Your cancer doctor and specialist nurse can explain if the treatment you are having is likely to cause an early menopause.

What are the symptoms of menopause?

The change in hormone levels can cause symptoms, including:

  • hot flushes and sweats
  • vaginal dryness
  • loss of interest in sex
  • difficulty sleeping
  • dry skin
  • aches and pains
  • needing to pass urine (pee) more often
  • weight gain
  • mood swings
  • loss of confidence
  • poor concentration.

Most women have some of these symptoms. The symptoms can vary from mild to more severe. For some women, they last for many years. The symptoms are sometimes worse if menopause has happened suddenly because of cancer treatments.

You may need blood tests to find out if treatment has caused an early menopause.

Infertility and menopause

A permanent menopause means that you will not be able to have children (infertility). Infertility can be very difficult to deal with, especially if you wanted to get pregnant. It can be particularly hard when you are already coping with cancer.

It may be helpful to talk about your feelings with a partner, if you have one, family and friends, or your specialist nurse or cancer doctor. If you feel you need more help, ask about being referred to a counsellor.

We have more information about cancer and fertility in women.

Possible long-term effects of menopause

Menopause, and particularly early menopause may increase the risk of bone thinning (osteoporosis) and heart disease. There are ways to reduce these risks.

  • Bone thinning (osteoporosis)

    Oestrogen helps maintain bone calcium levels and bone density. The risk of osteoporosis is higher after menopause. Tell your cancer doctor if other people in your family have had osteoporosis.Regular weight bearing exercise and a diet with plenty calcium and vitamin D will help you to look after your bones. If you have breast cancer you may need a scan to check your bone density before you take hormonal therapy drugs called aromatase inhibitors. Depending on the results some women may need to take drugs called bisphosphonates to help look after their bones.

  • Heart disease

    The risk of heart disease in women increases after menopause. Some cancer treatments may also affect the heart. You can improve your heart health at any age. Even small changes can make a difference.

Hormone replacement treatment (HRT)

Depending on the type of cancer you have, you may be able to take HRT. This replaces the hormones your ovaries are no longer producing.

But if you have a hormone-related cancer, such as breast cancer, doctors do not usually recommend HRT. It contains oestrogen which may increase the risk of the cancer coming back.

In other cancers when treatment causes an early menopause your doctor may prescribe HRT. It can improve menopausal symptoms and help protect your bones and heart. Ask your cancer doctor if HRT is suitable for you. HRT has benefits and risks so it is important to talk with your doctor before taking it.

You can take HRT as:

  • a tablet
  • skin patches
  • a gel to rub into the skin
  • an implant.

If your cancer doctor does not recommend HRT for you or you do not want to take it, there are other ways to manage menopause symptoms.

Practical tips for managing menopausal symptoms

There are practical ways to reduce menopausal symptoms. Your cancer doctor can also prescribe drugs or treatments that can help.

What you choose to do will depend on:

  • your personal preferences
  • the possible risks and benefits
  • the symptoms you have and how much they affect you
  • what other treatments you are having.

Hot flushes and sweating

This is the most common menopausal symptom. Hot flushes can vary from a slight feeling of warmth in the face to night sweats that affect your whole body.

Hot flushes generally last for about 4 to 5 minutes. You may feel sudden warmth in your face, neck and chest. You may become flushed and sweaty. You might also feel your heart beating faster (palpitations) during a flush.

We have practical tips to help with hot flushes and sweating.

Medicines to help with hot flushes

Talk to your doctor about medicines to reduce hot flushes and sweats. There are different medicines they may prescribe:

  • Antidepressants

    Your GP might prescribe antidepressants such as venlafaxine, paroxetine and fluoxetine. These may reduce the frequency and severity of hot flushes by 50% in some women. It usually takes 1 to 4 weeks for antidepressants to help with hot flushes. Side effects of antidepressants can include headaches, feeling sick, loss of appetite, a dry mouth and constipation. Some antidepressants can affect sleep. Talk to your doctor if you are having problems sleeping.

  • Gabapentin (Neurontin®)

    Gabapentin is a drug that is mainly used to control epilepsy. But it is also effective at reducing hot flushes. Possible side effects include feeling very tired, drowsy or dizzy.

  • Clonidine (Catapres®, Dixarit®)

    Clonidine is a drug used to treat high blood pressure or migraines. It can help reduce hot flushes and sweats in some women. It can take 4 weeks to work. Side effects include constipation, a dry mouth and drowsiness.

Vaginal dryness

Having a low level of oestrogen can cause vaginal dryness and itching. It can also make having sex uncomfortable or painful.

Creams and lubricants

There are specially designed vaginal creams that can help. These include non-hormonal creams that you apply 2 to 3 times a week. Water-based lubricants can help reduce discomfort from vaginal dryness during sex.

Some creams can damage condoms and diaphragms. So you may need to use another type of contraception to make sure you do not get pregnant. Your specialist nurse or cancer doctor can tell you more about suitable products.

Other vaginal treatments

Some treatments for vaginal dryness contain a small amount of oestrogen. Very little of the oestrogen is absorbed.

If you have a hormone related cancer, such as breast cancer, ask your cancer doctor if it is safe for you to use one of these treatments. Some breast specialists may prescribe them for short periods of time.

Treatments containing oestrogen:

  • Vagifem®

    Vagifem® is a tablet that you insert into the vagina (a pessary). You normally use it daily for 2 weeks, and then reduce the dosage to twice a week.

  • Ovestin® and Gynest®

    Ovestin® and Gynest® are vaginal creams that contain a small amount of oestrogen. They can help reduce dryness and itching for a short time.

  • Estring®

    Estring® is a vaginal ring that is placed inside the upper third of the vagina. It is left in place for 90 days and then replaced with a new ring. It slowly releases a small amount of oestrogen and may help reduce dryness.

Loss of interest in sex

Losing interest in sex can happen for lots of reasons. It can be a symptom of menopause. But it can also happen if you are tired, stressed or worried because 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 improve your sex life. Talk to your doctor or specialist nurse if you are having problems with your sex life. There may be treatments that can help. Or they may be able to refer you to a sex therapist or counsellor.

Passing urine more often

During menopause, you may pass urine (pee) more often. You may also have some urine leakage and be more likely to get urine infections (urinary tract infections or UTIs).

It is important to drink enough fluid to keep your bladder healthy. Try to drink at least 1½ litres (3 pints) a day. If you do not drink enough, your urine will become concentrated and irritate the bladder. You will also be more likely to develop a urine infection.

If you have problems with urine leakage, doing regular pelvic floor exercises (Kegel exercises) can help. These exercises strengthen the muscles that hold urine in the bladder. Your specialist nurse or doctor can explain how to do these exercises, or you can order a leaflet from the Bladder and Bowel Community.

Speak to your doctor if you develop symptoms of a urine infection. Symptoms include cloudy or smelly urine and pain or discomfort when passing urine.

Difficulty sleeping

You may have difficulty sleeping because of hot flushes, sweats or anxiety. We have more information about coping with sleeping problems.

Psychological effects

The psychological effects of menopausal symptoms can be hard to cope with, especially when you are also dealing with cancer.

Psychological effects of menopausal symptoms can include:

  • mood swings
  • lack of confidence
  • loss of concentration and memory
  • feeling very emotional or anxious.

Many women find it helpful to talk about their feelings with family and friends, or their cancer doctor or specialist nurse. There are organisations that provide support to women going through menopause, such as The Daisy Network. Some women may find counselling helpful. Your cancer doctor or specialist nurse can give you more advice.

Complementary therapies for managing menopausal symptoms

Some complementary therapies, such as controlled breathing, yoga or acupuncture, may help control your menopausal symptoms. Some of these therapies may be available on the NHS. Your GP can give you more details. If you would like to find a complementary therapist, make sure they are properly qualified and registered.

It is a good idea to talk to your cancer doctor or specialist nurse before using a complementary therapy. Some therapies may affect how your cancer treatment works.

Breathing techniques

Two research trials have shown that using a slow, controlled breathing technique can be an effective way to manage hot flushes. This is called paced respiration. The results showed that the number of flushes was reduced, on average, by 50% to 60%.

To develop paced respiration, it is important to practice for 15 minutes, twice a day. Find a quiet place where you can sit comfortably without being interrupted while you practice the following exercise:

  • Keep your rib cage still and breathe in and out by pushing out and pulling in your tummy muscles (using your abdominal muscles).
  • Without moving your rib cage, breathe in for 5 seconds and then breathe out for 5 seconds.

When you are confident doing paced respiration, you can use it whenever you feel a flush starting. You should continue with paced respiration until you feel the flush has passed.

A yoga breathing technique known as the cooling breath or sheetali can also help to reduce your body temperature. Contact the British Wheel of Yoga to find a registered yoga teacher near you.

Acupuncture

Acupuncture involves putting sterile needles through the skin at specific points in the body. There is some evidence that acupuncture may help reduce the frequency and severity of hot flushes.

After surgery to the lymph nodes in the armpit to treat breast cancer you need to try to avoid having needles in the arm or chest on that side. This is because of the risk of arm swelling called lymphoedema.

Always ask your cancer doctor or specialist nurse if acupuncture is safe for you.

Hypnosis

Some evidence suggests that hypnosis may help reduce the length and severity of hot flushes. It is unlikely to be available on the NHS. Contact the British Complementary Medicine Association to find a registered practitioner.

Homeopathy

This uses tiny amounts of substances that would normally produce the symptoms being treated. There is no scientific proof that this works. But some women feel that it improves their menopausal symptoms.

Plant oestrogens

Plant oestrogens (phytoestrogens) can have a weak oestrogen-like effect on the body and may help improve menopause symptoms. But there is not enough evidence about how helpful or how safe they are.

Doctors advise women with breast cancer not to take plant oestrogens. This is because there is a concern they may increase the risk of breast cancer coming back.

If you are planning to take them, it is important to talk to your cancer doctor first. The most commonly used plant oestrogens are black cohosh and red clover.

  • Black cohosh

    Black cohosh contains phytoestrogens and may help improve hot flushes. But the evidence is not clear. Side effects include sickness (nausea), vomiting, headaches and possible liver damage.

  • Red clover

    Red clover contains chemicals called isoflavones, which are a type of phytoestrogen. There is less evidence as to whether or not it can help reduce menopausal symptoms. It may increase the risk of bleeding. This means women taking medication to thin the blood (anticoagulants) should not use it.

Other supplements

Evening primrose oil

Some women find evening primrose oil helpful for relieving menopausal symptoms. But it is expensive and there is no scientific evidence that it works.

Sage

Some women find taking sage tablets or drinking sage tea helps reduce hot flushes. But there is no strong evidence that it works.

Vitamin E

There is no good evidence to suggest that vitamin E helps reduce menopausal symptoms. Its use is not recommended.

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