Menopausal symptoms

Some breast cancer treatments (for example, chemotherapy) can cause changes in estrogen levels that lead to menstrual cycles becoming irregular, pausing, or stopping.

Some treatments can cause temporary menopause, and others can cause permanent menopause. Even if you went through menopause naturally before treatment, treatment can sometimes bring new symptoms, or changes in how you've experienced symptoms.

What are menopausal symptoms?

Menopausal symptoms can vary, but some symptoms may include:

• Hot flashes
• Cold flashes
• Night sweats
• Fatigue and sleep difficulty
• Mood swings
• Weight gain
• Dry hair and skin
• Thinning hair
• Vaginal and vulvar dryness
• Pain during sex
• Changes in sexual desire
• Thinning of the bones

For many women, menopausal symptoms are among the most frustrating treatment side effects, and can make it a challenge to stay on long-term treatments such as hormonal therapy. But there are many ways to manage these symptoms so you can continue treatment.

Natural vs. medical menopause

If you have not gone through menopause yet, you are either premenopausal or perimenopausal:

• In premenopause, your ovaries make most of the estrogen in your body and you have regular periods.
• In perimenopause, your ovaries make less estrogen as your body prepares to stop your regular menstrual cycle. You may have periods once in a while, but they do not happen regularly. You may also experience hot flashes and heaving bleeding during your period.

Natural menopause and medical menopause are two different experiences.

Natural menopause:

• Typically happens at around age 50, but age of menopause can be highly individual
• Tends to be gradual; the perimenopausal transition takes place over several years

Medical menopause:

• Is sudden
• Can result in symptoms that are more severe than natural menopause
• Is caused by anti-cancer treatments that either:
  • Remove the ovaries with a surgery called oophorectomy, which causes permanent menopause
  • Temporarily stop the ovaries from making estrogen by using ovarian suppression medicines

If you are being treated with ovarian suppression medicines and you are already very close to the time that you would naturally start menopause, it's more likely that your periods will not return when you stop taking the medicine.

Below, you can learn more about why menopausal symptoms happen, and ways to manage them.

What causes menopausal symptoms?

Menopausal symptoms can be a side effect of many treatments for breast cancer, including:

• Treatments such as ovary removal, ovarian suppression, or chemotherapy, which can permanently or temporarily stop the ovaries from making estrogen
• Treatments such as hormonal therapy, which lowers estrogen in the body or blocks estrogen for women with hormone receptor-positive breast cancer

Oophorectomy

If you test positive for an inherited BRCA1 or BRCA2 mutation, the risk of developing breast cancer and ovarian cancer is significantly higher than for women who do not carry these mutations. Your care team will talk with you about ways to reduce that risk. One risk-reducing strategy is surgery to remove the ovaries, a procedure called oophorectomy. With the ovaries no longer there to make estrogen, you will go through medical menopause.

Ovarian suppression

For some pre- or perimenopausal women, ovarian suppression may be recommended. Ovarian suppression uses medicines such as leuprolide (Lupron) and goserelin (Zoladex) to stop the ovaries from making estrogen. This causes short-term menopausal symptoms that last while you are receiving the medicine and for a short time afterward, but allows you to keep your ovaries. If you're already close to natural menopause when you stop taking the medicine, you may be in permanent menopause when you stop taking it.

Chemotherapy

Chemotherapy works by killing rapidly dividing cancer cells. The cells in your ovaries that contain eggs, called follicles, also divide rapidly, so the eggs may also be hurt or damaged by chemotherapy. When follicles are damaged, the ovaries don’t work as well. This can disrupt your periods or cause menopausal side effects such as hot flashes and night sweats.

Menopausal symptoms might begin as soon as your first treatment cycle, but you can also develop them later during treatment. Your periods may suddenly stop or become irregular.

Whether your symptoms are permanent or temporary depends on many factors, including your age at treatment and the type of chemotherapy you receive. Studies show that the younger you are and the further away you are from natural menopause, the more likely it is that your periods will return. It can take 6 months to a year or longer for periods to resume normally after finishing chemotherapy.

Some chemotherapy medicines, such as cyclophosphamide (Cytoxan), are more likely than others to cause menopausal symptoms. But any chemotherapy regimen has the potential to cause menopause or menopausal symptoms.

If you are premenopausal and chemotherapy has been recommended for you, talk with your care team about the likelihood of menopausal symptoms.

Hormonal therapy

Hormonal therapy is approved to treat hormone receptor-positive breast cancer. These treatments interfere with estrogen in different ways:

• Tamoxifen, approved for pre- and postmenopausal women, blocks estrogen from attaching to estrogen receptors on breast cancer cells. Without estrogen, the cancer cells can't grow as well as they can with it.
• Aromatase inhibitors, approved for postmenopausal women, interfere with an enzyme to lower estrogen levels in the body. With lower estrogen levels, hormone receptor-positive breast cancer is less able to grow.

These treatments can cause many different menopausal symptoms, including:

• Hot flashes
• Vaginal and vulvar dryness
• Fatigue
• Bone thinning or pain
• Muscle and joint pain
• Hair thinning
• Nausea
• Loss of interest in sex

In some situations, premenopausal women are given ovarian suppressing medicines so that they can get the benefit of taking aromatase inhibitors. And even if you've already gone through natural menopause, hormonal therapies can still cause menopausal side effects.

Hormonal therapy needs to be taken every day, so it's important to talk about side effects with your team.

How can I manage or prevent menopausal symptoms?

Each person responds differently to different treatments. These tips may help you manage symptoms:

• Avoid spicy or greasy food, caffeine, and alcohol if you have hot flashes.
• Eat more whole grains, brown rice, lean protein, and greens.
• Keep cool. Wear layers of light fabrics and keep a cold drink handy.
• Sleep on cotton bed sheets and use a fan or air conditioning.
• Try complementary therapies such as massage or acupuncture.
• Ask your doctor about antidepressants or other medicines that may relieve symptoms.
• Exercise for 20 minutes a day.
• Maintain a healthy weight.
• Use non-hormonal vaginal lubricants and moisturizers to lessen discomfort during sex. Your care team can suggest options.
• If non-hormonal vaginal treatments don't work well, ask your care team if low-dose vaginal estrogen creams, rings, or tablets are an option. In 2023, JAMA Oncology published research that found vaginal estrogen, including vaginal tablets and creams, did not increase the risk of dying from breast cancer. Still, each situation is highly individual, and your risk is unique. If you're considering vaginal estrogen, talk with your team about your individual risk. The American College of Obstetricians and Gynecologists (ACOG) has stated that people with a history of breast cancer, including people who are taking tamoxifen, may use low-dose vaginal estrogen. ACOG recommends that people taking aromatase inhibitors first talk with their oncologists and gynecologists about whether low-dose vaginal estrogen is right for them.

If you are pre- or perimenopausal and have a male partner, it is important to keep using non-hormonal birth control. It is still possible to get pregnant, even if your periods have stopped. Consider using condoms, an IUD without hormones, or a diaphragm. Learn more about your options on our birth control and breast cancer page.

Menopausal symptoms and fertility

If you are premenopausal and you want to have children, it's important to know that the breast cancer treatments we've talked about on this page can affect fertility in different ways. Being in temporary or permanent menopause means it can be very difficult to get pregnant, or that you can no longer get pregnant. And it's not safe for a growing baby if you are taking hormonal therapy while pregnant.

The good news is that there are many ways to protect your fertility from the effects of breast cancer treatment. Visit our fertility section to learn about protecting your fertility.

Menopausal symptoms and metastatic breast cancer treatment

Some ongoing treatments for metastatic breast cancer (MBC) can result in ongoing menopausal symptoms. If you've been diagnosed with MBC, talk with your care team about the risk of menopausal symptoms with your treatment plan, and ways to manage them if they happen.

Menopausal symptom-causing treatments approved for hormone receptor-positive MBC include:

• Oophorectomy
• Ovarian suppressing medicines
• Chemotherapy
• Hormonal therapy: aromatase inhibitors, fulvestrant (Faslodex), elacestrant (Orserdu), and toremifene citrate (Fareston)

Here are some of the common menopausal symptoms that can happen with ongoing treatment for MBC:

• Hormonal therapy and bone metastases can cause bone loss and bone pain, which may be more severe than it is for early-stage disease. Your care team may recommend bone density tests, such as DEXA scans, to monitor for bone loss and see how well bone-strengthening medicines are working.
• If chemotherapy has been recommended for you, there's a possibility that it may cause menopausal symptoms such as vaginal and vulvar dryness and hot flashes. But unlike early-stage breast cancer chemotherapy regimens, which often combine more than one drug, chemo in MBC is usually given using one drug at a time. For some people, this may mean fewer chemotherapy-related menopausal symptoms, depending on other medicines they may be taking at the same time.
• Vaginal and vulvar dryness and loss of libido can also happen because of the discomfort caused by multiple treatments, as well as emotional factors. When you’re going through all these treatments, it's not always easy to find the time, energy, or desire to have sex. Patience and open communication with your partner can help. You can learn more at our page on navigating intimacy and sexuality with metastatic breast cancer.