Menopausal symptoms and cancer treatment

Some cancer treatments can cause an early or temporary menopause, or side effects similar to menopausal symptoms. There are different ways of managing and reducing menopausal symptoms.
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About menopausal symptoms and cancer treatment

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

Before the menopause, the ovaries produce the hormones oestrogen and progesterone. These control your monthly cycle (periods). During the menopause, the ovaries stop producing these hormones and periods gradually stop. 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 whether 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 menopausal symptoms. These include:

  • 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 people have some of these symptoms. The symptoms can vary from mild to more severe. For some people, they last for many years. The symptoms are sometimes worse if the menopause starts suddenly because of cancer treatments.

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

Infertility and menopause

A permanent menopause means that you will not be able to have children. This is called 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 your partner, if you have one, or your family and friends. You can also talk to your 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

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
  • 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.

Your GP might prescribe anti-depressants such as venlafaxine or citalopram. It usually takes 1 to 4 weeks for anti-depressants to help with hot flushes. Side effects of anti-depressants include:

  • headaches
  • feeling sick
  • loss of appetite
  • a dry mouth
  • constipation.

Some anti-depressants can affect sleep. Talk to your GP if you are having problems sleeping.

If you are taking tamoxifen for breast cancer, you should not take anti-depressants called paroxetine or fluoxetine. This is because they can affect the way tamoxifen works. Your GP can give you more advice on what might help in your situation.

Oxybutinin is a drug normally used to treat incontinence, but studies have shown that it can help with hot flushes. Oxybutinin is not suitable for everyone. Your cancer doctor, nurse or GP can talk to you about whether it might be helpful in your situation.

You might be offered a hormonal drug called megestrol acetate. Your cancer doctor or nurse will explain more about this if they think it might help in your situation.

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 special 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. You may need to use another type of contraception to avoid getting pregnant. Your 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. Only a small amount of the oestrogen is absorbed by the body.

If you have a hormone-related cancer, such as breast cancer, ask your cancer doctor whether it is safe for you have treatments containing oestrogen. Some breast specialists may prescribe them for short periods of time.

Treatments containing oestrogen include:

  • Vagifem®

    Vagifem® is a tablet that you insert into the vagina. This is called a pessary. You normally use it daily for 2 weeks. You then reduce the dose to 2 times 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 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 you are coping with cancer and its treatments. Other menopausal symptoms can also reduce your interest in sex, such as hot flushes and vaginal dryness.

Treating the cause may improve your sex life. Talk to your GP or nurse if you are having problems with your sex life. There may be treatments that can help. Your doctor 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 have some urine leakage (incontinence). You are also more likely to get urinary tract infections (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 can help. These are called Kegel exercises. They strengthen the muscles that hold urine in the bladder. Your practice nurse or GP can explain how to do these exercises, or you can order a leaflet from the Bladder and Bowel Community.

Speak to your GP 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 include:

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

You may find it helpful to talk about feelings with family and friends, or your cancer doctor or nurse. Some people find counselling helpful.

Organisations such as Menopause and cancer also have lots of helpful information. They also have a podcast discussing cancer and the menopause.

Possible long-term effects of menopause

The 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 the menopause. Tell your cancer doctor if other people in your family have had osteoporosis. You can help look after your bones by doing regular weightbearing exercise and having plenty of calcium and vitamin D in your diet. 

    If you are taking hormonal therapy drugs called aromatase inhibitors (AIs), you may need a scan to check your bone density. Depending on the results, you may need to take drugs called  bisphosphonates to help slow down osteoporosis.

  • Heart disease

    The risk of heart disease in women increases after the 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 hormone replacement treatment. This is called 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 GP may prescribe HRT. It can improve menopausal symptoms and help protect your bones and heart. Ask your cancer doctor whether HRT is suitable for you. HRT has benefits and risks, so it is important to talk to 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 menopausal symptoms.

Complementary therapies for managing menopausal symptoms

Some complementary therapies, may help to control menopausal symptoms. Examples of complementary therapies include:

  • a controlled breathing method called paced respiration
  • yoga
  • acupuncture.

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 nurse before having 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 method can sometimes help manage hot flushes. This is called paced respiration.

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

  • Keep your rib cage still and breathe in and out by pushing out and pulling in your tummy muscles (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.

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, you need to try to avoid having needles in the arm or chest on the treated side. This is because of the risk of the arm swelling (lymphoedema).

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

Hypnosis

Some evidence suggests that hypnosis may help reduce the length and severity of hot flushes. Hypnosis 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 people feel that it improves their menopausal symptoms.

Plant oestrogens

Naturally occurring oestrogens can be found in plants. These are called phytoestrogens. They can have a weak oestrogen-like effect on the body and may help improve menopausal symptoms. If you have or have had breast cancer, your doctors will advise you not to take plant oestrogens, as there is not enough evidence about how helpful or safe they are.

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 that it is effective. 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 for whether red clover can help reduce menopausal symptoms. It may increase the risk of bleeding. You should not use it if you take medication to thin the blood (anticoagulants).

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.

About our information

  • 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

Reviewed: 01 October 2023
|
Next review: 01 October 2026
Trusted Information Creator - Patient Information Forum
Trusted Information Creator - Patient Information Forum

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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