Some surgeries, chemotherapies, and hormonal therapies can cause temporary or permanent menopause. Even if you went through menopause naturally before treatment, you could have symptoms or changes again, or more intensely than you did before.
Menopausal symptoms can vary, but some symptoms may include:
- Hot flashes
- Cold flashes
- Night sweats
- Sleep troubles
- Mood swings
- Weight gain
- Dry hair and skin
- Thinning hair
- Vaginal dryness or tightness
- Pain during sex
- Changes in sexual desire
- Thinning of the bones
For many women, menopausal symptoms are among the most frustrating. Some women feel such discomfort they decide to change or stop hormonal therapy because of them. But there are many ways to manage these symptoms so you can continue treatment. Here is more information and tips to help you talk with your providers about what you are feeling.
If you did not go 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, your ovaries make less estrogen as your body prepares to stop your regular menstrual cycle. You may have periods once in a while, but they do not happen regularly.
Natural menopause, which typically happens at around age 50, tends to be gradual. It takes place over several years. But medical menopause is sudden and its symptoms can be more severe than natural menopause. Medical menopause is caused by anti-cancer therapies that either remove the ovaries or stop them from making estrogen.
Menopausal symptoms related to breast cancer treatment can be short-term or permanent.
If you test positive for a BRCA1 or BRCA2 mutation, your doctor may recommend surgery to remove your ovaries, a procedure called oophorectomy. With the ovaries no longer there to make estrogen, you will go through menopause.
For some pre- or perimenopausal women, ovarian suppression may be recommended. Ovarian suppression uses medicines to stop the ovaries from making estrogen. It causes short-term menopausal symptoms that last while you are receiving the medicine and for a short time afterward but allows you to keep your ovaries.
Chemotherapy works by killing quickly dividing cancer cells. The cells in your ovaries that have eggs, called follicles, also divide rapidly, so the eggs may also be hurt or damaged by chemotherapy. When follicles are damaged, the ovaries don’t work as well. This can disrupt your menstrual cycle or cause menopausal side effects like hot flashes and night sweats.
Menopausal symptoms might begin as soon as your first treatment cycle, but you can also develop them later on. Your periods may suddenly stop or become irregular.
Whether your symptoms are permanent or temporary depends on many factors, including your age at treatment and the type of chemotherapy you receive. Studies show that the younger you are and the further away you are from natural menopause, the more likely your periods will return. Periods can sometimes return a year or longer after finishing chemotherapy.
Some chemotherapy medicines, such as cyclophosphamide (Cytoxan), are more likely than others to cause menopause or menopausal symptoms. But any chemotherapy regimen has the potential to cause menopause or menopausal symptoms. These regimens, which have cyclophosphamide, are associated with menopausal symptoms
- ACT, which combines doxorubicin (Adriamycin), cyclophosphamide (Cytoxan), and paclitaxel (Taxol)
- CMF, which combines cyclophosphamide, methotrexate, and fluorouracil (5-FU)
Hormonal therapy works by stopping estrogen from binding to the estrogen receptor. This keeps estrogen from doing its job or stops the body from making estrogen. In either case, you could have menopausal symptoms.
If you are premenopausal, hormonal therapies can cause sudden, short-term menopausal symptoms. Tamoxifen, a standard hormonal therapy for premenopausal women, prompts hot flashes. It blocks estrogen receptors in the brain that control body temperature and other functions. Medicines that suppress the ovaries, like leuprolide (Lupron) and goserelin (Zoladex), also cause temporary menopausal side effects.
Hormonal therapies can cause menopausal side effects even if you naturally went through menopause. These medicines need to be taken every day so talking about side effects with your team is important.
Each person responds differently to different treatments. These tips may help you deal with symptoms:
- Avoid spicy or greasy food, caffeine and alcohol. 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 like massage or acupuncture
- Ask your doctor about antidepressants or other medicines that may relieve symptoms
- Exercise for 20 minutes a day
- Maintain a healthy weight
- Use vaginal lubricants and moisturizers to lessen discomfort during sex. Your providers can suggest options
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.