Dealing with menopausal symptoms

The menopause happens when a woman’s periods stop and she can no longer have children. This happens because the ovaries stop producing the sex hormones oestrogen and progesterone. The average age for a natural menopause in women in Ireland is 52 years. In some women, symptoms can last for several months or years. 
 
Some breast cancer treatments may put you into an early or temporary menopause or cause menopausal-like symptoms. A menopause caused by breast cancer treatment can be quite sudden and symptoms are often more intense than when the menopause occurs naturally.

Breast cancer treatments and menopausal symptoms

Some breast cancers are encouraged to grow by the hormone oestrogen in your body. Many breast cancer treatments are therefore used to reduce oestrogen levels or block the action of oestrogen.
 
Menopausal symptoms can occur as a side-effect of chemotherapy, hormone therapy, or ovarian ablation. Ovarian ablation is the term used to describe removing your ovaries or stopping them from working.
 
For younger women who are still having periods, cancer treatment may cause early menopause. This can be temporary or permanent. If you have had the menopause and are having hormone therapy you are also likely to experience menopausal symptoms while on treatment.

What are the most common menopausal symptoms?

The most common menopausal symptoms include:
 
  • Hot flushes / night sweats
     
  • Vaginal dryness
     
  • Decreased sex drive
     
  • Mood changes
     
  • General aches and pains
     
  • Poor concentration
     
  • Insomnia (sleeplessness)
     
Women can have one or more of these menopausal symptoms, which can range from mild to severe. The menopause, and particularly an early menopause, may also cause bone thinning (osteoporosis). Your doctor or nurse can advise you about how to prevent bone thinning. 
 
You may feel anxious and depressed and sometimes it can be hard to work out if this is an actual menopausal symptom or due to a recent diagnosis of breast cancer. If you feel this way for more than a week, you should talk to your doctor.
 

Coping with hot flushes

Hot flushes can vary from being a mild sensation of warming to a very unpleasant feeling which affects your whole body and causes heavy sweating. A hot flush usually lasts 4 or 5 minutes but can last for just a few seconds or up to 10 minutes.

Some women who have hot flushes also feel their heartbeat racing (palpitations) or develop a sense of anxiety. Usually, these flushes become less severe over time but for some women they can be long‑lasting.

 

Complementary therapies

Many women use a range of complementary therapies to ease the symptoms of menopause. These therapies include acupuncture, reflexology, massage, meditation, aromatherapy and homeopathy.
 
If you decide to use complementary therapies, it is important that you go to a recognised, qualified practitioner. Always discuss complementary therapies with your cancer specialist or GP to ensure they are safe to use along with any other medication you are taking.
 

Dealing with hot flushes

The following tips may help to ease the effects of hot flushes:
  • Avoid warm areas and use an electric fan to lower your skin temperature.
  • You may find it helpful to avoid certain foods and drinks such as spicy foods, caffeine, alcohol, sugar and hot drinks. 
  • Avoid hot baths or showers, as they may trigger a hot flush.
  • Wear cotton or special wicking-fabric clothing. Cotton absorbs moisture and wicking fabrics take moisture away from the body to keep you dry and comfortable.
  • Wear layers of clothing so that you can remove or add clothing as your body temperature changes.
  • Use several layers of cotton or wicking fabric bed linen that can be removed as needed.
  • Keep a cool gel pack under your pillow at night for a cooling effect when you need it.
  • Use sprays or moist wipes to help lower your skin temperature. You could add aromatherapy oils to the spray, such as cooling peppermint or relaxing lavender.
  • Drinking cold drinks can help.
  • Regular exercise, such as going for a walk, may help reduce your symptoms.
     
Women who are not active tend to have more hot flushes.
  • If you are overweight, losing weight can help to reduce your symptoms.
  • If you smoke, stopping may help reduce your symptoms.
     

Relaxation

Many women find that reducing stress can help to ease their symptoms. This can mean different things for different people. For example, you could take up a stress-relieving activity such as yoga, t’ai chi or meditation. Research has shown that a slow, controlled breathing technique called paced respiration can help to manage hot flushes.
 

Dietary supplements

  • Phytoestrogens (plant oestrogens)
Phytoestrogens are chemicals found in plant foods. High quantities of phytoestrogens are found in foods such as soya beans and linseed. Phytoestrogens may help to relieve menopausal symptoms by mimicking the effects of oestrogen in the body. However, when taken in greater amounts than found in a normal diet, there is concern that they may also increase the risk of breast cancer coming back.
 
There has been a lot of research into the use of phytoestrogens, but we are still unsure about how safe and effective they are. Remember that it is important to discuss any dietary supplements with your cancer specialist or breast care nurse before taking them.
 
  • Evening primrose oil
Some women find evening primrose oil helpful, but there is no scientific evidence that it works.
 

Prescribed drug therapies

  • Hormone replacement therapy (HRT)
HRT replaces the hormones that are no longer being produced by your ovaries. Most doctors do not recommend taking HRT after a breast cancer diagnosis, as it can increase the risk of cancer coming back. Your doctor may prescribe HRT in certain cases, particularly if you are having very severe menopausal symptoms. But you need to discuss this in detail with your doctor to make sure you are clear about the possible risks and benefits.
 
  • Antidepressant drugs
There is some evidence that the antidepressant drug venlafaxine (Effexor®) can help to control hot flushes for some women. Side-effects might include indigestion and nausea.
 
  • Clonidine
Clonidine is mainly used to control high blood pressure. It has also been shown to be effective in reducing the number and the intensity of hot flushes in some women. Side-effects include constipation, skin problems and drowsiness.
 
  • Gabapentin
Some women have found an anti-epilepsy drug called gabapentin (Neurontin®) helpful in reducing the severity of hot flushes. Side-effects include extreme tiredness (fatigue), sleep disturbance and anxiety.
 
  • Low-dose progesterone
Progesterone in low doses has been shown to reduce hot flushes. However, many doctors have concerns about using any hormones in women who have had breast cancer. 
 
It is important to discuss fully with your doctor the possible benefits and side-effects of these drugs.
 

Vaginal dryness

Low oestrogen levels can result in vaginal dryness, irritation and discomfort during sex. There are a number of different creams and gels available to help with vaginal dryness. Vaginal moisturisers such as Replens® and Hyalofemme® are available from your pharmacy and can be used every few days. If you experience discomfort during sex, water-based lubricants such as KY® Jelly, Astroglide®, Sylk ® and Yes ® (available from your pharmacy) may help. 
 
There are also some treatments that contain a small amount of oestrogen, such as a tablet that you put into your vagina or a vaginal ring that is worn for 3 months. These may help to reduce dryness, but do talk to your specialist or breast care nurse before you use any products containing oestrogen.
 

Decreased sex drive

Breast cancer can affect your sex drive for many reasons. It may be a result of the diagnosis itself, treatment side-effects, or concerns about the way your body looks. The impact this has on your sex drive sometimes becomes less over time, as you adjust to the treatment. It can help to take your time and not rush things.
 
Try to be open and talk to your partner about how you feel. Although it can be difficult, just talking about it to someone else may help. Talk to your GP, specialist or breast care nurse if you are having sexual problems, as there are ways of helping you to deal with them, such as medical treatments and specialist sex therapy or counselling. 
 

Mood changes

You may find that you are experiencing extreme mood changes, from very happy to very sad. A change in mood can happen unexpectedly and for no apparent reason. Relaxation classes, meditation, yoga and similar activities can be a useful way of controlling mood changes.
 
Sometimes joining a support group where you can talk to other women with similar experiences can help. If you find you cannot cope with your mood changes, talk to your doctor or breast care nurse. They may refer you to a counsellor or therapist who can help. For more information on individual support or support groups in your area, call the Irish Cancer Society Cancer Nurseline on Freephone 1800 200 700.
 

Bone thinning (osteoporosis)

Any breast cancer treatment that results in lower than normal oestrogen levels can lead to bone-thinning (osteoporosis). This can cause bones to become brittle and may result in fractures (broken bones). If your menopause has been brought on early because of treatment or if you are starting to take aromatase inhibitors, you should have a DEXA scan to check your bone density. Research has shown that bone-strengthening drugs can slow down and prevent osteoporosis but do not relieve other menopausal symptoms.
 
Exercise is important for your bone health and will help to build up your bones again. But it has to be exercise that puts pressure on your bones (weight-bearing exercise), such as walking, cycling or exercise in the gym. Many of us do not take enough regular exercise. The best way to fix this is to gradually bring exercise into your daily life.
 

Taking care of your bones

Some breast cancer treatments can lead to bone thinning. Here are some tips to improve bone strength:
  • Take regular exercise such as walking, cycling or working out at the gym.
     
  • Make sure your diet has plenty of calcium-rich foods like cheese, sardines, yogurt and green, leafy vegetables.
     
  • Keep a healthy weight.
     
  • Avoid caffeine and alcohol.
     
  • Stop smoking
     
  • Make sure you take any bone-loss medication prescribed for you.
 
Calcium and vitamin D are essential for good bone health, so it is important to have a well-balanced diet. Calcium-rich foods include cheese, yogurt, green leafy vegetables and some fish, like sardines and pilchards. Vitamin D helps the body to use calcium effectively.
 
Calcium and vitamin D supplements can help strengthen bones. Your doctor can advise you on your diet and any supplements you may need to take.
 
Smoking has been shown to increase your risk of osteoporosis, so it is important to stop smoking or cut down  to reduce your risk. Caffeine and alcohol can interfere with your body’s calcium levels, so it is best to cut down on these too.

Further support

If you are concerned about your menopausal symptoms, talk to your cancer specialist or breast care nurse. You might also find it easier to share your feelings with someone who has had a similar experience to you. For example, Survivors Supporting Survivors is a programme set up to help and support women who have recently had a breast cancer diagnosis.
 
The programme involves personal contact between you and a Survivors Supporting Survivors volunteer. This is a woman who has had treatment for breast cancer. Carefully selected and fully trained volunteers are available to provide advice and reassurance at a time when you need it most.

For more information on individual support or support groups in your area, call the Irish Cancer Society Cancer Nurseline on Freephone 1800 200 700 or visit a Daffodil Centre.

Call our Cancer Nurseline

Freephone 1800 200 700 to talk to a specialist cancer nurse
It's open Monday-Thursday from 9am to 6pm and Friday from 9am to 5pm

Date Last Reviewed: 
Wednesday, July 15, 2015
Date Last Revised: 
Wednesday, July 15, 2015