Menopause and cancer (SPARC)

A surgical or medically induced menopause can be triggered by a range of cancer treatments. This is where hormone production (mainly oestrogen) reduces or stops, and periods reduce or stop.

This short film explains more about the menopause and cancer LINK

After cancer treatment, many women experience symptoms related to menopause. This can happen because certain cancer treatments, like surgery, chemotherapy, radiation, or hormone therapy can lower oestrogen levels, triggering these symptoms.

For many women, this sudden drop in hormones can feel like being thrown into menopause overnight, because oestrogen affects so many systems in the body, the impact can be wide-ranging, from affecting sleep, energy levels and mood.

Systemic anticancer therapy (SACT)

Chemotherapy is one of the most common treatments for cancer, and it works by targeting rapidly dividing cancer cells. It is often used alongside other systemic anti-cancer treatments such as monoclonal antibodies and immunotherapy.

Chemotherapy cannot differentiate between a cancer cell and any other cell in your body which divides more rapidly and can also affect the healthy cells, such as in your ovaries, which may lead to a temporary or permanent shutdown of ovarian function.

Hormone Therapy

Some cancers, like breast cancer, are sensitive to hormones like oestrogen and progesterone. In these cases, hormone therapy, such as aromatase inhibitors like letrozole, or selective oestrogen receptor modulators like tamoxifen, may be used to block these hormones.

While these medications do not directly cause menopause, they can trigger symptoms similar to those of menopause by reducing available oestrogen levels in the body.

Monthly or three-monthly injections such as prostap or zoladex reduce direct oestrogen production from the ovaries. These medically switch ovarian function off and also cause the symptoms of a menopause.

Radiation Therapy

Radiation therapy, particularly when it’s targeted at areas like the pelvic region, can damage the ovaries, potentially leading to early menopause. This is more likely if you’re receiving radiation at a higher dose or if you’re in your 30’s or 40’s.

These effects might be temporary, but in some situations, there can be a permanent loss of ovarian function.

Surgery

If you’ve had surgery to remove your ovaries, either as a preventive measure or because of cancer, this will immediately cause menopause, regardless of your age. This is known as surgical menopause, and it can bring on symptoms more abruptly than a physiological menopause.

While each treatment may affect your body in different ways, it’s important to know that you don’t have to face these challenges alone. There are ways to manage the symptoms of early menopause and get support along the way. 

Health Risks of Early Menopause

Going through menopause earlier than expected can increase the risk of other health problems, such as:

• Difficulty conceiving (potential loss of fertility) may occur. If preserving fertility is important to you, we would recommend discussing this with your doctor to explore options, including a referral for fertility preservation. See Fertility pages for more information.
• Thinning bones (osteoporosis) is a risk for all women going through the menopause and it is important to start and maintain regular weight bearing exercise, ideally 3 sessions per week with daily vitamin D. Bone health can be monitored via a bone density scan (DEXA). See Bone health for more information.
• Heart disease. It is important to maintain a healthy balanced diet and regular exercise, no smoking, people over 50 should monitor their cholesterol levels with their GP.

These risks will vary from person to person. For example, bladder issues or sexual difficulties may be higher for women who had cancer treatment in the pelvic area, like radiation.

Hormone Replacement Therapy (HRT) and Cancer            

Hormone Replacement Therapy, or HRT, is a common treatment to help manage menopause symptoms. It can also help protect against health problems like osteoporosis, especially in women under 60. For many women with early menopause, the benefits of HRT are greater than the risks.

However, if you had cancer, especially a hormone-sensitive cancer (like certain types of uterine or breast cancer), your doctor will need to consider this when discussing treatment options.

In many cases, non-hormonal treatments, or local therapies like vaginal oestrogen, which is absorbed very minimally, may still be safe and helpful. In some situations, even systemic HRT might be appropriate. That’s why it’s so important to speak with your clinical team or a menopause specialist.

They can look at your individual circumstances and help guide you toward the safest and most effective way to manage your symptoms and improve your quality of life.

Symptoms of menopause

As well as changes to your period, there are many other common signs and symptoms of menopause, these can look very different for everyone and may fluctuate. Common symptoms include:

• Hot flushes
• Vaginal dryness
• Changes in concentration, or memory
• Changes in mood
• Fatigue
• Pain
• Sleep changes/insomnia
• Incontinence and bladder problems
• Weight changes
• Painful sex

This page will include some information and practical tips that can help with the various symptoms of menopause.

It is important to speak to your cancer team or GP about options available and whether certain hormonal-based treatments including certain moisturisers or hormone replacement therapy (HRT) would be suitable for you dependent on your type of cancer.

It may be that you had already gone through the menopause, and that due to your cancer diagnosis this has impacted management strategies you were already using, and you may need to think of alternative options.

Hot Flushes

Hot flushes or hot flashes can be one of the most disruptive symptoms. These sudden feelings of heat can make you sweat and feel uncomfortable and can occur during the day and night.

Some women also experience cold flushes, which feel like sudden chills instead of heat. In many cases, flushes can come with other symptoms like a palpitations or dizziness, which can make the whole experience feel quite unsettling and uncomfortable.

Here are some non-medical ways to manage them:

• Dress in layers so you can remove clothing when you feel a flush coming on.
• Stay cool with a fan, cool drinks, or by using cooling aids like gel packs.
• Identify and avoid your triggers like spicy foods, caffeine, or alcohol, which can sometimes make hot flushes worse.
• Practice relaxation techniques like deep breathing or mindfulness to reduce stress, which can also trigger hot flushes.
• Some women explore alternative therapies like acupuncture, hypnosis, or homeopathy. While these may offer relief for some, it’s important to know that scientific evidence supporting them is still limited.

For women who need medical support in addition to the practical tips above, there are non-hormonal prescription medications that can help reduce hot flushes. The older medicines were all developed for other reasons but have been found to also help with hot flushes.

SSRIs or SNRIs which are classed as anti-depressant or anti-anxiety medications, also act on the temperature regulation centre of the brain to suppress hot flushes, night sweats, allay anxiety and improve mood.

Gabapentin and pregabalin, typically used for nerve pain or epilepsy, can also help by reduce the severity and duration of hot flushes by modulating neurotransmitter activity

Clonidine is an alpha-agonist, sometimes used to manage high blood pressure, but it can also help reduce hot flushes by affecting the brain’s regulation of body temperature.

Oxybutinin is typically used to treat bladder urgency but has been found to reduce hot flushes as well.

Newer medication options Elinzanetant and Fezolinetant, are medications that work by blocking specific receptors in the brain involved in regulating temperature and heat (neurokinin-3 (NK3) receptor).

Early studies show it may provide effective relief with fewer side effects compared to other treatments by targeting these receptors to reduce the frequency and severity of hot flushes.

These may be especially promising for women with hormone-sensitive cancers, such as breast cancer, who need to avoid traditional hormone therapy.

There are several medication options available, including newer treatments, which offer promising alternatives to traditional hormone therapies. However, it’s important to remember that the right medication for you depends on your unique medical history, including your cancer treatment history.

Always discuss your symptoms and treatment options with your healthcare provider to find the best and safest approach for managing your hot flushes.

Vaginal Dryness or Urinary Symptoms

During the menopause transition and after, many women experience changes like vaginal dryness, irritation, discomfort during sex, or urinary symptoms.

This is called Genitourinary Syndrome of Menopause, and it happens because of lower oestrogen levels affecting the vagina, vulva, bladder, and urethra. These symptoms can get worse over time if not treated, but the good news is there are effective options.

You can try non-hormonal vaginal moisturisers to keep the area hydrated and comfortable. During intimacy avoid lubricants with glycerin or propylene glycol, as they can cause irritation or thrush and use water-based lubricants.

For some women, low-dose vaginal oestrogen can be very helpful and is absorbed only minimally into the body. It’s important to speak with your clinical team or a menopause specialist to find the right option for you.

For further information see the Vaginal dryness pages.

Changes in concentration or memory – Brain Fog

Brain fog can make it harder to focus or remember things. While it’s frustrating, there are ways to cope:

• Break tasks into smaller steps to stay organized and reduce mental fatigue.
• Stay mentally active by engaging in activities that challenge your brain, like puzzles or learning new skills.
• Ensure you’re getting enough rest, as poor sleep can exacerbate brain fog.
• Use diaries and apps on phones as a reminder for important tasks

See Cognitive changes page for more information and guidance.

Mood Changes

Some people may notice changes to their mood and emotional wellbeing due to fluctuating hormone levels or because of the impact of living with symptoms of the menopause.

This can feel difficult to deal with but there are things that can help such as relaxation, breathing and mindfulness exercises, journalling to process and express your feelings, talking to family and friends or to others going through a similar experience, or accessing psychological support if needed.

To seek help you can ask for a referral to the cancer psychological support team, speak to your GP or self-refer to Talking Therapies.

Please see our video on managing with the psychological impact of cancer for more information and guidance.

Fatigue

Fatigue is a feeling of exhaustion, even after a full night’s sleep.

To manage it, use the 5 P’s:

1. Pace yourself with breaks
2. Plan your day to avoid rushing
3. Prioritise what matters most
4. Give yourself permission to rest
5. Maintain good posture to reduce strain.

It may sound strange but being active can give you energy and help reduce fatigue.

Pain

Joint pain is common during menopause, often due to lower oestrogen levels affecting joint lubrication.

• Regular movement helps to manage this pain, daily walks, stretches and gentle activities like yoga or Tai Chi can ease stiffness and improve flexibility.
• Swimming and aquafit are excellent low-impact options, especially if you experience hot flushes, as the water keeps you cool while you move.
• Strength training is also important, it supports bone health and muscle strength.
• Warm baths, heating pads, or cold packs can help soothe sore joints.

We would also advise maintaining a healthy weight, as excess weight can put extra strain on your joints.

Sleep

Sleep problems are common during menopause, often caused by hot flushes, night sweats, fatigue, or side effects from cancer treatments.

You might struggle to fall asleep, stay asleep, or feel rested. To help, try creating a calming bedtime routine, limit naps, stay active, reduce caffeine and alcohol, and practice relaxation techniques.

There are various apps that can help improve sleep, see the Sleep pages for more information.

Incontinence or bladder problems

Please see the bladder problems pages for more information and helpful tips.

Weight changes

Many people notice weight gain during and after menopause, especially around the abdomen. This can be because of the hormonal changes, where lower oestrogen levels cause fat storage to transfer from the legs to the abdomen. Please see Healthy eating pages for more information.

Painful sex

Some people experience painful sex (which is called dyspareunia) after menopause. This is because lower oestrogen levels can cause vaginal dryness, thinning or loss of elasticity of the vaginal tissues and fragility of tissues.

Regular application of vaginal moisturisers improves vaginal hydration. Use of a water-based lubricant when being intimate or having sex can reduce the friction experienced. As can longer periods of arousal, to increase the natural lubrication. Avoiding irritants such as harsh cleansers or scented soaps.

Some people find it helpful to think about different ways to be intimate if they are struggling with painful sex.

See sex and intimacy pages for more information.

Resources/More information:

SGH Menopause leaflet – link to follow

This is a resource for anyone going through the menopause and includes a range of holistic and non-hormonal strategies

Menopause and cancer – Macmillan Cancer Support

Menopause and cancer – website and podcasts, Q&A sessions with clinicians

British Menopause Society videos

Women’s Health Concern – Confidential Advice, Reassurance and Education

Charity for Women with POI | The Daisy Network

Menopause resources for LGBTQIA+ people

Who can help

Speak with your GP or cancer team about prescribing vaginal moisturisers, lubricants or HRT where appropriate.

Speak with your cancer team who may be able to offer support or refer you to a menopause clinic.

Maggie’s centres offer advice, support and workshops on cancer and menopause

Menopause and Cancer offer resources, podcasts, support groups and workshops: Home – Menopause and Cancer with Dani Binnington.