Menopausal symptoms and breast cancer - This factsheet is for women who are experiencing menopausal symptoms after breast cancer treatment.
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Menopausal symptoms and breast cancer This factsheet is for women who are experiencing menopausal symptoms after breast cancer treatment.
Introduction Some of the more common
menopausal symptoms include hot
The menopause is a natural and flushes, night sweats, palpitations,
inevitable event for all women. The mood changes, joint aches and pains
average age at which a natural and vaginal dryness. You may put on
menopause occurs in women in the UK weight, with the weight being more
is 51 years, with symptoms usually concentrated around the waist. More
spanning a period of several years. rarely, some women experience a
However, the treatment some women crawling sensation under the skin,
receive for breast cancer can cause an usually on the chest and stomach. You
earlier menopause and/or significant may find that you become anxious and
menopausal symptoms. irritable or have problems with memory
or concentration. The changes you
Some breast cancers (known as
notice in your body may be gradual but
oestrogen receptor positive or ER
for some women changes like hot
positive breast cancers) are stimulated
flushes can start suddenly.
to grow by the hormone oestrogen.
Many breast cancer treatments are This factsheet covers a range of
therefore designed to reduce oestrogen treatment options, including
levels or block the action of complementary therapies and
oestrogen, which can cause specifically prescribed drugs to help
menopausal symptoms. Menopausal you cope with these symptoms. The
symptoms can arise as a result of effectiveness of some of the treatments
hormone therapy treatment or ovarian (particularly the non-prescription
ablation or suppression (stopping the therapies) are not supported by
ovaries working either permanently or scientific evidence, but many women
temporarily) in ER positive women. have found them useful. However, it is
also important to consider the safety of
Women having chemotherapy may have
non-prescription therapies.
an earlier, more sudden menopause as a
result of treatment. Symptoms are often Different treatments work for different
more intense than when the menopause women and it can be a case of trial and
occurs naturally, whether they are error until you find something suitable.
oestrogen receptor positive or not. If If you decide to try something new, talk
periods only stop temporarily during to your specialist or breast care nurse.
chemotherapy, menopausal symptoms
may still be experienced.
2 Menopausal symptoms and breast cancerWhat can you do to help flushes?
Hot flushes
You might feel that you should put up
Hot flushes are the most commonly
with hot flushes because you have
reported menopausal symptom
been treated for breast cancer, but
associated with breast cancer
they can be very distressing. You may
treatment. They can vary greatly from
think that you shouldn’t bother anyone
being a mild sensation of warming
about them, but it is worth speaking to
which just affects the face or the whole
your specialist team or GP (local
of the upper body, to night sweats
doctor) as there may be treatments
which are an extremely unpleasant
that can help. If you attend a support
feeling affecting the entire body and
group, talking to other women who are
causing drenching perspiration. For
having hot flushes can give you the
most people flushes will fade over time
opportunity to share experiences and
and become less severe, but for some
get advice on ways of dealing with
women they can be long lasting.
them. You may wish to use the
Some women become aware of their discussion forums on the Breast
heartbeat racing (palpitations) or Cancer Care website to gain support
develop a sense of anxiety. Many and tips from other women who have
women also get flushes at night, which experienced these side effects.
can lead to disturbed sleep and
It may be useful to keep a note of
waking in a cold, wet bed and needing
when you experience hot flushes. This
to change the bed linen. This can be
can help you to identify any patterns to
very disruptive, especially if you share
them or if anything triggers them that
a bed and may be worried about
you might be able to avoid. If you
disturbing your partner. Disturbed
know when to expect hot flushes you
sleep due to hot flushes can result in
can be better prepared for them.
forgetfulness, irritability and a lack of
concentration during the following day.
You may consider hot flushes to be a
nuisance or uncomfortable but some
women find flushes can have a
dramatic impact on the way they feel
about themselves. This can have a
knock-on effect on their social life,
working life and personal relationships.
Menopausal symptoms and breast cancer 3Tips for dealing with hot flushes • If you are not sleeping well, try to
find time to have a rest during the day.
The following tips have been
recommended by other women and • Avoid warm, stuffy rooms as they
may help you cope better with hot can make flushes worse.
flushes and night sweats.
• Regular, gentle exercise, such as
• Wear cotton or silk clothing as these going for a walk, may help reduce your
fabrics absorb moisture and still symptoms.
provide warmth after a flush is over.
• Stopping smoking may help, as
• Wear layers of clothing that can be smoking increases the rate at which
taken off or put on as your body the body uses oestrogen, which
temperature changes. means there is less oestrogen in the
body.
• Use layers of bedclothes (natural
fabrics are better) that you can remove • If you have hot flushes from
or replace as required. For couples tamoxifen, it may help to split the dose
sharing the same bed, using single (for example taking 10 mg in the
bedclothes on each side can help you morning and 10 mg at night). Some
both stay comfortable. women find that the brand of
tamoxifen they take affects the number
• Put a cool gel pack under your pillow
of flushes they get. Ask your GP,
at night so that you can turn the pillow
cancer specialist or breast care nurse
over for a cooling effect when you
for more information about this.
need to. Many women have found a
pillow that stays cool, such as a
‘Chillow’, useful.
• Use water sprays or moist wipes to
help lower your skin temperature. You
could try adding an aromatherapy oil
to the spray, such as peppermint
which has cooling properties or
lavender which has a relaxing effect.
• Use an electric fan to help lower your
skin temperature or a desk fan while at
work if you can.
4 Menopausal symptoms and breast cancerRelaxation Complementary therapies
Many women find that reducing stress Some women find complementary
makes their symptoms less severe. therapies help with relaxation and
This might just mean learning to relieve hot flushes. There are many to
become calmer, which may be choose from, including homeopathy,
achieved by using controlled breathing acupuncture, reflexology, massage,
techniques, or might involve doing aromatherapy, hypnotherapy and
things to reduce stress, such as meditation.
relaxation, increasing rest time or
Acupuncture has been shown to be
decreasing work demands.
effective for some women, although
Being anxious about hot flushes can the evidence for its use is inconsistent.
make your symptoms worse. Knowing Massage with aromatherapy oils such
what to expect and being prepared as sage or chamomile may also help
can help you feel more in control and improve hot flushes, but again there is
reduce your anxiety. no evidence to support this.
Hot flushes usually come and go over If you want to try a complementary
short periods, so try to relax and wait approach you should discuss this with
for the sensation to pass. When you your specialist team first. It is
feel a hot flush coming on, you may advisable to go to a qualified
find it helps to imagine yourself in a practitioner. For further information,
cool place. It may also help to know see Useful addresses at the end of this
that although hot flushes are factsheet or our Complementary
uncomfortable for you, other people therapies booklet.
are unlikely to notice them happening.
Menopausal symptoms and breast cancer 5Diet Evening primrose oil
Food can be one of the triggers for Some women have found taking
flushes and some women find that evening primrose oil helpful, but, as
specific things, such as spicy foods, with vitamin E, studies have shown it
caffeine or alcohol, have this effect. to have no more benefit than a
You will need to work out for yourself placebo and there is currently no
what your triggers are. Some women evidence to support its use for
find that eating frequent small meals reducing or preventing hot flushes.
rather than larger ones is helpful.
Phytoestrogens (plant oestrogens)
Drinking cold drinks frequently has
been reported as helpful for some Phytoestrogens are chemicals found in
women, as it temporarily lowers your plant foods. There is a variety of them,
body temperature and may reduce the all with different actions, although in
number of flushes. Reducing your general they mimic the effect of
alcohol intake may also help. oestrogen in the body. It is unclear if
they help to reduce hot flushes.
If you are overweight, losing weight
Phytoestrogens are found in many
may reduce your symptoms.
fruits, vegetables and grains. There are
Maintaining long-term health, taking
high quantities of them in foods such
regular exercise and stopping or
as soya beans and linseed. You can
reducing smoking may also help.
buy phytoestrogen-rich foods from
Vitamin E health food shops. It is also possible
to buy supplements of extracted
A few women report that taking
phytoestrogen in powder form, such
vitamin E tablets helps to reduce the
as soy protein and isoflavones.
number of hot flushes they have,
although some trials have shown There has been a lot of research to
vitamin E has no more benefit than a examine the use of soy proteins and
placebo (a ‘dummy’ pill) and in large other phytoestrogens to relieve hot
doses vitamin E is toxic. Check with flushes, but the results are inconsistent
your GP or cancer specialist before regarding their safety and
you start taking any supplements and effectiveness. It is currently uncertain
never take more than the what effect phytoestrogens have on
recommended dose. the body when they are taken in
greater amounts than found in a
normal diet. It is also not clear whether
6 Menopausal symptoms and breast cancerthe amount of plant oestrogen in your Herbal remedies
body has any effect on the risk of your
Some women find herbal remedies to
cancer coming back.
be an effective way of reducing hot
As with herbal remedies, flushes. However, opinion is divided on
phytoestrogens are classified as whether they are suitable and safe for
foodstuffs and so are not covered by use, or if they have any more effect
drug regulations and clinical trials (see than a placebo. They are classed as
below). foodstuffs, which means they don’t
come under the same regulations as
other drugs. This means they don’t go
through thorough clinical trials before
being put on the market and their side
effects or interaction with other drugs
or treatments (e.g. tamoxifen or
aromatase inhibitors) may not be
known.
Some herbal remedies, such as red
clover, may help to reduce hot flushes
because they contain phytoestrogens,
but as indicated above their safety and
how effective they are has yet to be
established in women who have been
treated for breast cancer. Wild yam,
ginseng and fennel contain a mixture
of many hormone-like substances, but
the way in which they work is not
entirely clear. Black cohosh does not
appear to have any hormonal actions
although the evidence is unclear, and
the limited number of studies have
shown inconsistent findings regarding
its effectiveness. This remedy has also
been reported to give side-effects
such as dizziness, headaches or
stomach upsets. There may also be a
Menopausal symptoms and breast cancer 7risk of liver problems in women who Prescribed drug therapies
already have pre-existing liver disease.
The following drugs have all been
It is important to consult a registered shown to help relieve hot flushes and
herbalist and discuss any herbal would need to be prescribed by a
supplements with your cancer doctor.
specialist or breast care nurse before
Low-dose progesterone
taking them, particularly if you are
having hormone treatment such as Progesterone in low doses can be
tamoxifen or aromatase inhibitors. effective in relieving hot flushes,
although there is no evidence it is
effective in reducing symptoms in the
long term. Many doctors are hesitant
to give any hormones to women who
have had breast cancer and for this
reason they are not often prescribed
in women who have had a breast
cancer diagnosis.
These drugs include megestrol
(Megace), medroxyprogesterone
(Provera) and norethisterone (Primolut
N, Utovlan). Side effects from these
drugs can include weight gain,
abdominal bloating and breast
tenderness. You may also experience
vaginal bleeding one or two weeks after
progesterone treatment is stopped as
hormones return to their normal levels.
Clonidine (Dixarit, Catapres)
Clonidine can be effective in some
women in reducing both the frequency
and the intensity of hot flushes but its
effects may wear off over time. As with
all drugs, clonidine can have side
effects, including a dry mouth,
8 Menopausal symptoms and breast cancerheadaches, constipation and Hormone Replacement Therapy
drowsiness. (HRT)
Anti-depressant drugs HRT replaces hormones that are no
longer being produced by the ovaries
The anti-depressant drug venlafaxine
and is a very effective way of relieving
(Effexor) has been shown in studies to
menopausal symptoms. It can also
have a good effect in reducing flushes
help to protect against long-term side
in some women, but may have
effects of the menopause such as
unpleasant side effects and its effect
osteoporosis. However, HRT is not
may wear off over time. It is prescribed
usually offered to women who have
in a different dose to help with hot
had breast cancer as there is still
flushes than when prescribed for
uncertainty if HRT increases the risk of
depression, and is not expected to
breast cancer recurring. Some studies
have anti-depressant effects. Side
report that HRT causes cancer to come
effects might include nausea,
back and others that it doesn’t, so the
diarrhoea, sleepiness and dizziness.
safety of HRT is still unclear.
The anti-depressant drugs fluoxetine
(Prozac) and paroxetine (Seroxat), are A small number of women experience
also sometimes prescribed to help severe menopausal symptoms that
reduce hot flushes, and have similar significantly affect their quality of life
side-effects to venlafaxine. However, and that don’t respond to other
some studies suggest that using these treatments or complementary
drugs may interfere with the way that therapies. In these cases HRT may be
tamoxifen works, making it less prescribed because the benefits are
effective. likely to outweigh any possible risk.
This would be done only once your
Gabapentin (Neurontin)
cancer specialist has discussed all the
Some women have found an risks and benefits with you in order to
anti-epilepsy drug, gabapentin, helpful decide whether it is appropriate. A full
in reducing the severity of hot flushes. dose of HRT may not be necessary to
As with all drugs, gabapentin can have reduce hot flushes, so it would be
side effects, including fatigue, sleep possible to try using smaller amounts.
disturbance and anxiety.
Menopausal symptoms and breast cancer 9Vaginal dryness oestrogen absorbed into the rest of the
body is not fully known, but it is
Low oestrogen levels can result in thought to be low and therefore safe in
vaginal dryness and irritation. Wearing the short term, for example three
loose-fitting cotton underwear and months at a time.
avoiding tight-fitting trousers can help,
The vaginal tablet, Vagifem, can also
as this is less likely to irritate the
cause a small increase in the level of
vaginal area.
oestrogen in your body. It is advisable
Vaginal moisturisers such as Replens to discuss the use of these locally
MD or Senselle (available from acting oestrogens with your cancer
chemists and on prescription) may be specialist.
used every few days. If you experience
discomfort during sexual intercourse it
may be helpful to apply water-based
lubricants such as KY jelly, Astroglide,
Pasante TLC or Sylk. These products
don’t generally cause vaginal irritation
and are fine to use with condoms.
Some women find that spermicidal gel
or even natural yogurt can help make
intercourse more comfortable. If you
can get past the initial dryness, then
intercourse itself helps to stimulate the
blood flow to the vagina and will help
maintain its suppleness and elasticity.
Vaginal dryness and irritation can also
be caused by infection, so it is best to
visit your GP if you are experiencing
problems so they can rule this out.
Oestrogen pessaries and creams such
as Ortho-Gynest and the vaginal ring,
Estring, act locally on the vaginal
tissues and may relieve dryness
effectively. The exact amount of
10 Menopausal symptoms and breast cancerDecreased sex drive Mood changes
People with breast cancer may lose The brain can be affected by a
interest in sex for many reasons. It may reduction in oestrogen levels, which
be a result of the diagnosis itself, can result in lack of concentration,
treatment or side effects, or concerns forgetfulness and irritability. You may
with body image. If this is a problem for find that you are experiencing extreme
you, talk to your GP, specialist or breast mood changes, from feeling positive
care nurse, as there are ways of helping and happy one day to miserable and
you deal with these issues. low the next. These can happen
unexpectedly and for no apparent
Menopausal symptoms such as hot
reason.
flushes and night sweats as well as a
decreased sex drive can effect new Relaxation classes, meditation, yoga
and existing relationships and your sex and other similar activities can be
life. You may find it difficult to start a useful ways of controlling mood
new relationship at this time. You can changes. These won’t be appropriate
find more information on vaginal for everyone, but it is worth trying a few
dryness, decreased sex drive and to see if any of them work for you.
relationships in our booklet Sexuality, Talking about your feelings can be
intimacy and breast cancer. helpful and you may find it useful to
discuss these with other women who
are going through a similar experience.
You can call our helpline for information
on our Peer support service or visit the
discussion forums on our website.
There may also be a breast cancer
support group in your area, your breast
care nurse will be able to tell you if
there is.
Menopausal symptoms and breast cancer 11Further support Further help from
Any menopausal problems that you are Breast Cancer Care
having are in addition to the experience
For further medical information,
of cancer itself, the treatment and its
emotional support, and details of our
side effects. Flushes may be the one
services, call our helpline free on 0808
thing that is stopping you gaining some
800 6000 (for Typetalk prefix 18001).
normality and for some women can be
a constant reminder of their breast Breast Cancer Care’s website has an
cancer experience. For others, having email enquiries service called Ask the
this problem on top of everything else nurse, along with forums and live chat
makes them feel very low. If you find sessions where you can share your
that you are unable to cope or that you views with people in a similar situation.
keep feeling down, try talking with your For more information about these
GP or breast care nurse. They may be services and other online support, visit
able to refer you to a professional www.breastcancercare.org.uk
counsellor or therapist who can help.
We run courses and activities for
You may also be referred to a specialist
people with breast cancer, which aim to
menopause clinic if there is one in your
provide information and support and
local area, where you can get further
give people the chance to meet others
advice and information about coping
in a similar situation. For more
with menopausal symptoms.
information about these events, call our
helpline or contact your nearest Breast
Cancer Care centre details on the
reverse.
Breast Cancer Care also has a wide
range of publications to guide you from
diagnosis to living well after treatment.
You can download and order our
publications at
www.breastcancercare.org.uk or call
our helpline on 0808 800 6000 for a
printed order form.
12 Menopausal symptoms and breast cancerOther organisations Northwich CW8 1AQ
Telephone: 01606 786782
British Complementary Medicine Email:
Association (BCMA) admin@medical-acupuncture.org.uk
PO Box 5122, Bournemouth BH8 0WG Website:
Tel: 0845 345 5977 www.medical-acupuncture.co.uk
Email: office@bcma.co.uk
Provides acupuncture information and
Website: www.bcma.co.uk
news, and a list of members who are all
Umbrella organisation. Produces a registered medical practitioners.
guide and a code of conduct for
British Menopause Society (BMS)
practitioners, and a holds a register of
4-6 Eton Place, Marlow SL7 2QA
practitioners.
Telephone: 01628 890199
British Holistic Medical Association Email: admin@thebms.org.uk
PO Box 371, Bridgewater, Website: www.thebms.org.uk
Somerset TA6 9BG
The BMS is a registered charity
Tel: 01278 722000
dedicated to increasing awareness of
Email: admin@bhma.org
post-menopausal healthcare issues
Website: www.bhma.org
and promoting optimal management
Provides information, produces through conferences, roadshows and
self-help tapes, booklets and a publications (see further reading).
quarterly magazine.
The Daisy Network
British Homeopathic Association PO Box 183, Rossendale BB4 6WZ
Hahnemann House, 29 Park Street Recorded helpline: 0845 122 8616
West, Luton LU1 3BE Tel: 0870 444 Email: daisy@daisynetwork.org.uk
3950 Email: info@trusthomeopathy.org Website: www.daisynetwork.org.uk
Website: www.trusthomeopathy.org
Voluntary support group for women
Provides information and a directory of who experience a premature
homeopaths. Produces a booklet menopause, including information
called ‘How to get Homeopathic exchange and informal telephone
Treatment on the NHS’ and a quarterly support by members.
magazine.
British Medical Acupuncture Society
BMAS House, 3 Winnington Court,
Menopausal symptoms and breast cancer 13Tel: 01273 609699
Institute for Complementary and Email: enquiries@naturalhealthas.com
Natural Medicine Website: www.naturalhealthas.com
Can-Mezzanine, 32-36 Loman Street,
Offers specific dietary, nutrition and
London SE1 0EH
exercise advice for women with
Tel: 020 7922 7980
pre-menstrual syndrome, menopausal
Email: info@icnm.org.uk
symptoms, prevention of osteoporosis
Website: www.i-c-m.org.uk
and other hormone-related problems.
Provides information, training and a
Penny Brohn Cancer Care
register of professional practitioners.
Chapel Pill Lane, Pill, Bristol BS20 0HH
The Menopause Exchange Helpline: 0845 123 2310 (Mon-Fri
PO Box 250, Bushey WD23 1ZS 9.30am-5pm)
Tel: 020 8420 7245 Email: helpline@pennybrohn.org
Website:
The Menopause Exchange is a
www.pennybrohncancercare.org
quarterly newsletter for anyone
interested in the menopause and Offers two and five day holistic courses
midlife issues. It specialises in (led by doctors and therapists) for
independent information about HRT, cancer patients which include
complementary therapies, nutrition, counselling, relaxation, visualisation,
osteoporosis. Annual subscrption starts meditation, art and music therapy,
at £18. healing and dietary advice. Helpline
offers emotional support, and
National Institute of Medical
information on finding complementary
Herbalists
therapists and services in your area.
Elm House, 54 Mary Arches Street,
Exeter EX4 3BA The Society of Homeopaths
Tel: 01392 426022 11 Brookfield, Duncan Close,
Email: info@nimh.org.uk Moulton Park, Northampton NN3 6WL
Website: www.nimh.org.uk Tel: 0845 450 6611
Email: info@homeopathy-soh.org
Produces information, training and a
Website: www.homeopathy-soh.org
register of qualified medical herbalists.
Provides information leaflets, news, a
Natural Health Advisory Service
register of members and a newsletter.
PO Box 117, Rottingdean, Brighton,
East Sussex BN51 9BG
14 Menopausal symptoms and breast cancerWomen’s Health Concern
4-6 Eton Place, Marlow, Further reading
Buckinghamshire SL7 2QA
Understanding the Menopause
Tel: 0845 123 2319 (Mon-Fri 10-1pm)
and HRT
Email:
Anne MacGregor Family Doctor
info@womens-health-concern.org
Publications, 2005 ISBN 1903474116
Website:
www.womens-health-concern.org Menopause
Miriam Stoppard Dorling Kindersley,
Specialist nurses will answer queries
London, 2002 ISBN 0789483572
about the menopause and a wide
variety of gynaecological and sexual Natural Menopause
health conditions. Miriam Stoppard Dorling Kindersley,
London, 2003 ISBN 0751369829
Websites
Books available from The British
www.chillow.net
Menopause Society
This website offers more information on
The Menopause: What You Need to
the chillow. Items can be purchased
Know
online or by phone on 0871 200 1533.
Rees, Purdie and Hope RSM Press,
www.menopausematters.co.uk 2006 ISBN 1853156728
Menopausematters.co.uk is an
independent, clinician-led website. It
aims to provide easily accessible,
up-to-date, accurate information about This factsheet has been produced by Breast
the menopause, menopausal Cancer Care’s clinical specialists and reviewed by
symptoms and treatment options, healthcare professionals and people affected by
breast cancer.
including Hormone Replacement
Therapy (HRT) and alternative Factsheet © Breast Cancer Care 2006. Revised
therapies, so that women and health November 2008. All rights are reserved. No part of
professionals can make informed this publication may be reproduced, stored or
transmitted, in any form or by any means, without
choices about menopause
the prior permission of the publishers.
management.
Registered charity in England and Wales 1017658
Registered charity in Scotland SC038104
Registered company in England 2447182
Menopausal symptoms and breast cancer 15Central Office
About Breast
Breast Cancer Care
5-13 Great Suffolk Street Cancer Care
London SE1 0NS
Breast Cancer Care is here for
Telephone 0845 092 0800
anyone affected by breast cancer.
Fax 0845 092 0820
Email info@breastcancercare.org.uk We bring people together, provide
information and support, and
Centres campaign for improved standards of
London and the South East care. We use our understanding of
of England people’s experience of breast
Telephone 0845 077 1895 cancer and our clinical expertise
Email src@breastcancercare.org.uk
in everything we do. Visit
Wales, South West and Central www.breastcancercare.org.uk
England or call our free helpline on 0808 800
Telephone 0845 077 1894 6000. Calls may be monitored for
Email cym@breastcancercare.org.uk
training purposes. Confidentiality is
East Midlands and the North maintained between callers and
of England Breast Cancer Care.
Telephone 0845 077 1893
Email nrc@breastcancercare.org.uk
Scotland and Northern Ireland
Telephone 0845 077 1892
Email sco@breastcancercare.org.uk
Donations from the public make it possible for us to provide
publications like this one free to people affected by breast cancer.
If you would like to make a donation, please send your cheque to:
Breast Cancer Care, RRKZ-ARZY-YCKG, 5-13 Great Suffolk Street,
London SE1 0NS. Or donate via our website at
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