Menopausal Symptoms After Breast Cancer

A breast cancer diagnosis can already feel overwhelming. You’re juggling appointments, treatment plans and worries about the future. You’re adjusting to changes in your body — and your life.

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Then come the hot flashes, the night sweats, the vaginal dryness and all the other markers of menopause. It can feel like your body is changing faster than you can keep up.

“Many breast cancer treatments can bring on menopausal symptoms,” acknowledges medical oncologist Erin Roesch, MD.

We talked to Dr. Roesch about the link between breast cancer treatment and menopause, whether it will last and how to make it more manageable.

How breast cancer treatment can affect menopause

Breast cancer itself doesn’t cause menopause. But treatments can. Let’s look at some common breast cancer treatments and how they affect menopause.

Chemotherapy: “Young women going through chemotherapy are often put into at least temporary menopause,” Dr. Roesch explains.
Hormone therapy for breast cancer (endocrine therapy): Treatments including tamoxifen and aromatase inhibitors can cause a return of hot flashes and vaginal dryness in women who’ve already gone through menopause. Ovarian suppression, which blocks ovaries from making estrogen and induces menopause in young women, can cause various menopausal symptoms.

Sometimes, menopause is temporary and will cease after you stop receiving treatment. Whether your ovarian function will return after treatment depends on a few factors, like:

Your age
Your treatment plan
How close you were to natural menopause

In some women, induced menopause will be permanent. That’s why your provider may discuss fertility preservation measures, like freezing your eggs, before treatment.

And even if you’ve already been through menopause, breast cancer treatment can bring on a resurgence of symptoms.

Common menopausal symptoms with breast cancer

Menopausal symptoms and breast cancer treatment side effects often overlap. Dr. Roesch says common symptoms of both include:

Hot flashes and cold sweats (vasomotor symptoms)
Vaginal dryness or thinning
Painful intercourse
Weight changes
Mood changes
Decreased sex drive
Cognitive changes, like “brain fog”
Trouble sleeping
Infertility

How to manage menopause symptoms with breast cancer

When you’re already coping with cancer, symptoms like sleep disruption, intimacy changes, mood shifts and more can feel especially heavy. But know that these are all common — and treatable.

But managing your menopause symptoms typically means taking a slightly different path. That’s because hormone replacement therapy — a common tool for managing menopause symptoms — isn’t usually recommended for anyone who’s been through breast cancer.

“Nonhormonal strategies are the standard approach for addressing menopause symptoms for breast cancer survivors,” Dr. Roesch reports. “But there are very select and individualized cases where the conversation may be more nuanced.”

The good news: There are other options. Let’s look at them.

Relief from vasomotor symptoms

Hot flashes and night sweats — also called vasomotor symptoms — are among the most common and disruptive symptoms of menopause.

Dr. Roesch says managing them often starts with lifestyle adjustments, such as:

Regular exercise
Stress management
Reducing caffeine intake

These steps may not completely eliminate symptoms, but they can make them less frequent or less intense.

If symptoms persist, medication can help.

Venlafaxine (Effexor^®) is one of the most commonly used medications for hot flashes after breast cancer treatment. Doctors typically start with a low dose and adjust it as needed based on how well symptoms respond.
Antidepressants (SSRIs and SNRIs) can help reduce the frequency and intensity of hot flashes. These medications may also help if you’re experiencing mood changes during cancer treatment or recovery.
Gabapentin is often used for nerve pain, and it can also reduce hot flashes. It may be especially helpful if you’re experiencing chemotherapy-related neuropathy (muscle weakness or tingling) along with vasomotor symptoms.
Fezolinetant (Veozah™) is a nonhormonal medication that targets your brain’s temperature control center. If you take it, you’ll need regular liver function monitoring — and it won’t be used if you have liver disease.

Sexual health treatments

It can be uncomfortable to share with your healthcare team, but breast cancer treatments can also cause changes to your sexual health. Among them: vaginal dryness, discomfort and decreased libido.

But there are nonhormonal treatments that are safe for people with breast cancer.

Water- or silicone-based lubricants can reduce friction and discomfort during sex.
Vaginal moisturizers are used regularly to improve tissue hydration.
Topical lidocaine can help with painful intercourse.
Low-dose vaginal estrogen or vaginal DHEA delivers small amounts of hormone directly to vaginal tissue, rather than circulating it throughout your body.
Pelvic floor therapy can help address pain, muscle tension and other physical symptoms that contribute to discomfort during sex.

Your sexual health can also be affected by other concerns, like how you see yourself, fatigue and stress. Working with a sexual health specialist may provide additional support.

“Addressing your sexual health concerns matters,” Dr. Roesch encourages. “We want you to live a full life while navigating cancer. So, don’t be afraid to bring up any concerns.”

Supporting bone health

Menopause and certain breast cancer treatments can also affect your bone density. Ovarian suppression, chemotherapy and aromatase inhibitors can contribute to bone loss. So, regular bone density tests (DXA scans) may be part of your treatment plan.

To support bone health, your care team may encourage you to do weight-bearing exercises. They may also recommend: