Menopausal symptoms

Some breast cancer treatments (for example, chemotherapy) can cause decreases or fluctuations 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, or sudden increases in body heat and sweating on the face, neck, and chest
• Cold flashes
• Night sweats, or intense periods of sweating while you are asleep
• Fatigue
• Sleep disruptions, including difficulty falling asleep, frequent awakening, and difficulty falling back to sleep
• Mood swings
• Weight gain and weight redistribution or increasing abdominal weight
• Dry hair, eyes, and skin
• Thinning hair
• Vaginal and vulvar dryness
• Pain during sex
• Lower sexual desire
• Thinning of the bones (osteopenia or osteoporosis)
• Joint aches
• Muscle pain
• Brain fog

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, estrogen levels fluctuate as your body prepares to stop your regular menstrual cycle. You may have periods once in a while, but they may not happen regularly. You may also experience menopausal symptoms such as hot flashes and heavy bleeding during your period.

Natural menopause and medical menopause are two different experiences.

The natural menopause transition:

• Typically happens at around age 50, but age of menopause can be highly individual
• Tends to be gradual, taking place over several years

Medical menopause:

• Is sudden
• Often results 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

Learn more about medical menopause on the Early menopause page.

If you are being treated with ovarian suppression medicines and you are already perimenopausal, 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.

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, acupuncture, or Mindfulness-based stress reduction
• Exercise for 20 minutes a day.
• Maintain a healthy weight.
• Ask your doctor about antidepressants or other medicines that may relieve hot flashes and night sweats.
• 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 March of 2025, the American Journal of Obstetrics and Gynecology published research showing that low-dose vaginal estrogen does not appear to be associated with increased risk in people with a history of breast cancer. It is generally viewed as safe when used in discussion with your medical oncologist. If you're considering vaginal estrogen, talk with your provider about your individual risk.

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

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.