Patient information leaflet from The Menopause Partnership (GP-led specialist care for women).
Understanding menopause after breast cancer
Menopause is a natural stage of life that all women will experience. The average age of menopause in the UK is around 51, although it can happen earlier or later for different people.
Breast cancer is also common. Around 1 in 7 women in the UK will develop breast cancer during their lifetime, and most cases occur in women over the age of 50. This means that many women going through menopause will either have had breast cancer in the past, or may develop it during midlife.
Some breast cancer treatments can also bring on menopause or worsen menopausal symptoms. Chemotherapy, ovarian suppression and hormone treatments can all trigger symptoms similar to those experienced in natural menopause.
As a result, many women experience menopause during or after breast cancer treatment, often at a younger age and sometimes with more severe symptoms. These can have a significant impact on sleep, mood, relationships, work and overall quality of life.
Understanding why this happens and what treatments are available can help you manage symptoms and improve your quality of life.
Many women find menopause after breast cancer particularly challenging because treatment options may appear limited or confusing. However, there are a number of safe and effective ways to manage symptoms.
At The Menopause Partnership, we believe it is important that women receive clear, evidence-based information and support to make informed decisions about their care.
Why might breast cancer treatment affect menopause?
Several treatments used for breast cancer reduce the levels of oestrogen in the body or block its effects. This can lead to menopausal symptoms.
Treatments that may cause menopause include:
- Chemotherapy
- Hormone therapies such as tamoxifen, anastrozole, letrozole or exemestane
- Ovarian suppression injections
- Surgical removal of the ovaries
- Radiotherapy affecting the ovaries
When menopause occurs suddenly as a result of treatment, symptoms may be more severe than during a natural menopause.
In some women, periods stop temporarily and return later. In others, menopause becomes permanent.
Common menopause symptoms
Menopause symptoms vary widely but may include:
- Hot flushes and night sweats
- Poor sleep and fatigue
- Anxiety, irritability or low mood
- Brain fog, memory problems and reduced concentration
- Joint and muscle pains
- Headaches or worsening migraines
- Vaginal dryness, irritation or pain during sex
- Bladder symptoms such as urgency or recurrent urinary infections
- Reduced sexual desire
- Skin and hair changes
Some symptoms may overlap with side effects of cancer treatment, which can make it difficult to identify the exact cause.
Menopause and long-term health
Oestrogen plays an important role in many body systems including:
- Bone health
- Cardiovascular health
- Brain function
- Genital and urinary tissues
If menopause occurs earlier than usual due to cancer treatment, women may have a longer lifetime exposure to low hormone levels, which can increase the risk of osteoporosis and cardiovascular disease.
Maintaining good overall health is therefore an important part of menopause care.
Lifestyle measures
Lifestyle approaches can improve symptoms and support long-term health.
Helpful steps include:
- Regular physical activity, including weight-bearing exercise
- Maintaining a healthy weight where possible
- Eating a balanced diet rich in vegetables, fruits and whole grains
- Limiting alcohol intake
- Stopping smoking
- Prioritising sleep and stress management
Exercise is particularly beneficial for bone strength, mood and energy levels.
Managing hot flushes and night sweats
Practical measures that may help include:
- Dressing in layers
- Keeping the bedroom cool and using breathable bedding or even cool pads
- Using a fan
- Identifying and avoiding triggers such as alcohol or spicy foods
- Practising relaxation techniques like paced breathing or mindfulness
Non-hormonal treatments may be helpful for flushes specifically, but unfortunately don’t usually give much benefit for other menopause symptoms.
Options include:
- Certain antidepressants such as Venlafaxine or Escitalopram
- Oxybutynin – usually used as a treatment for overactive bladder
- Gabapentin/Pregabalin
- Cognitive behavioural therapy (CBT)
Veozah (fezolinetant) is a new non-hormonal medication used to treat hot flushes and night sweats. It works by acting on temperature regulation centres in the brain rather than by replacing hormones.
Veozah has recently been approved by NICE for use in the UK, but it is not yet available on the NHS.
At The Menopause Partnership, we are able to assess whether Veozah may be appropriate for you and can prescribe it where suitable. Like all medications, it requires medical assessment and monitoring, including occasional blood tests to check liver function.
Veozah is specifically designed to treat vasomotor symptoms (hot flushes and night sweats) and does not treat other menopausal symptoms such as vaginal dryness, joint pains or sleep problems – though sleep often improves if night sweats are treated.
Vaginal dryness and bladder symptoms
These symptoms are very common after breast cancer treatment and can affect comfort, sex, sleep, exercise and confidence. They are part of what clinicians call genitourinary syndrome of menopause (GSM).
First steps
Many women with a history of breast cancer start with non-hormonal options such as:
- Vaginal moisturisers used regularly
- Lubricants for sex
- Avoiding perfumed washes, soaps and “intimate” products
- Treating possible urine infections promptly
- Pelvic floor support if bladder symptoms are an issue
However, for persistent symptoms these measures are often insufficient on their own.
Vaginal oestrogen treatment
For many women, low-dose vaginal oestrogen is the most effective treatment for GSM.
Vaginal oestrogen works locally in the vaginal tissues and only very small amounts are absorbed into the bloodstream.
Large observational studies involving breast cancer survivors have been reassuring and have not shown an increased risk of breast cancer recurrence or mortality in women using vaginal oestrogen.
European menopause societies and many specialist menopause clinics consider vaginal oestrogen to be safe for most women with a history of breast cancer, particularly when symptoms are severe and other treatments have not been effective.
For women taking aromatase inhibitors such as Letrozole and Anastrozole, changes may need to be considered before starting vaginal oestrogen treatment.
Mood, anxiety, sleep and brain fog
Menopause after breast cancer can affect emotional wellbeing as much as physical symptoms. Poor sleep, uncertainty, worry about recurrence and the effects of low oestrogen can all contribute.
Helpful approaches may include:
- Talking therapies
- Cognitive behavioural therapy (CBT)
- Mindfulness or relaxation techniques
- Support groups or peer support
- Treatment for anxiety or depression when needed
If your symptoms are severe, please ask for help. You do not need to “just put up with it”.
Bones, joints and long-term health
Low oestrogen levels can affect bone strength and increase the risk of osteoporosis. This matters particularly if menopause happens early, if you are on ovarian suppression, or if you are taking an aromatase inhibitor. NICE recommends bone health assessment in breast cancer care, and many patients need a DEXA scan.
Ask your team about:
- Bone density monitoring
- Calcium and vitamin D
- Weight-bearing exercise
- Medicines to protect bone strength if needed
Joint pains are also common with menopause and with some breast cancer treatments, especially aromatase inhibitors. Tell your team if pain is affecting movement, sleep or quality of life.
Can I use HRT after breast cancer?
This is often the hardest question. Systemic hormone replacement therapy (HRT) remains a complex and controversial area after breast cancer.
Current UK guidance
NICE guidance states that systemic HRT should not routinely be offered to women with a history of breast cancer.
However, NICE also recognises that in exceptional circumstances, HRT may be considered when symptoms are severe and other treatments have not helped.
Evidence and specialist practice
Evidence from observational studies over the past several decades has been mixed and unfortunately these studies are not always of a high quality, but overall does not demonstrate a clear increase in breast cancer mortality among women who use HRT after breast cancer.
Because of this uncertainty, many menopause specialists and international menopause societies recommend individualised care and shared decision making, particularly for women with severe symptoms affecting quality of life.
The safest plan is to try non-hormonal measures first. If systemic hormone therapy is considered, this should involve careful discussion with a menopause specialist and the woman’s breast or oncology team.
Shared decision making
Menopause treatment after breast cancer should always involve shared decision making between you and your healthcare professionals.
Factors considered include:
- The type of breast cancer you had
- Whether it was hormone receptor positive or negative
- Your current treatments
- Your risk of recurrence
- How severely symptoms affect your quality of life
There is rarely a single “right” answer — decisions should reflect your individual situation and preferences.
Talking to your healthcare team
If menopause symptoms are affecting your quality of life, it is important to seek advice.
You may find it helpful to:
- Keep a diary of symptoms
- Prepare questions before appointments
- Ask about referral to a menopause specialist clinic
You should feel supported in discussing all available treatment options.
When to seek help
Speak to your healthcare professional if:
- Menopause symptoms are affecting daily life or sleep
- Vaginal or bladder symptoms are persistent
- Side effects from cancer treatments are difficult to manage
- You are concerned about bone health, mood or sexual wellbeing
You should not feel that you need to manage symptoms alone.
Further support
Helpful organisations include:
- Menopause and Cancer
- Breast Cancer Now
- British Menopause Society
References
- Cancer Research UK.
Breast cancer statistics.
Available at: https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/breast-cancer
- National Institute for Health and Care Excellence (NICE).
Menopause: identification and management (NG23).
NICE guideline. Updated 2024.
https://www.nice.org.uk/guidance/ng23
- National Institute for Health and Care Excellence (NICE).
Early and locally advanced breast cancer: diagnosis and management (NG101).
Updated 2023.
https://www.nice.org.uk/guidance/ng101
- British Menopause Society (BMS).
The benefits and risks of HRT before and after a breast cancer diagnosis.
BMS Consensus Statement, 2023.
- British Menopause Society (BMS).
Non-hormonal-based treatments for menopausal symptoms.
BMS Consensus Statement, 2024 update.
- European Menopause and Andropause Society (EMAS).
Menopause management in women with a history of breast cancer.
Maturitas. 2021;143:82–88.
- North American Menopause Society (NAMS).
The 2022 hormone therapy position statement of the North American Menopause Society.
Menopause. 2022;29(7):767–794.
- Cold S., Cold F., Jensen M.B., Cronin-Fenton D., Christiansen P., Ejlertsen B.
Systemic or vaginal hormone therapy after early breast cancer: a Danish observational cohort study.
Journal of the National Cancer Institute. 2022;114(10):1347–1354.
- McVicker L., et al.
Vaginal estrogen therapy use and survival in females with breast cancer.
JAMA Oncology. 2024;10(1):103–108.
- Agrawal P., et al.
Safety of vaginal estrogen therapy for genitourinary syndrome of menopause in women with a history of breast cancer.
Obstetrics & Gynecology. 2023;142(3):660–668.
- Hussain I., Talaulikar V.S.
Safety of vaginal hormones and selective estrogen receptor modulators for treatment of genitourinary menopausal symptoms in breast cancer survivors: a systematic review of randomised clinical trials.
Post Reproductive Health. 2023;29(4):222–231.
- Holmberg L., Anderson H.
HABITS (Hormonal Replacement Therapy After Breast Cancer – Is It Safe?): a randomised comparison.
Lancet. 2004;363(9407):453–455.
- Peate M., Saunders C., Cohen P., et al.
Who is managing menopausal symptoms, sexual problems, mood and sleep disturbance after breast cancer? Findings from a community-based survey of breast cancer survivors.
Breast Cancer Research and Treatment. 2021;187:427–435.
- National Institute for Health and Care Excellence (NICE).
Fezolinetant for treating moderate to severe vasomotor symptoms associated with menopause.
NICE Technology Appraisal Guidance, 2024–2026 updates.
