Menopausal symptoms and cancer treatment

The menopause is when you stop having periods. It happens when your ovaries stop producing the same level of sex hormones. So the levels of oestrogen, progesterone and testosterone fall. Gradually your ovaries will stop producing eggs.

In the UK, the menopause usually happens around the age of 51 years. This happens in women, some trans men and some non-binary people.

You might start to have symptoms a few years or months before this. For example, your periods might be irregular and you might have heavier or lighter bleeding. This is called the peri menopause. For many, the peri menopause is a gradual process. You are usually menopausal when you have not had periods for 12 months.

An early menopause happens in women who are under 45. If you have your menopause under 40 years, this is called premature ovarian insufficiency (POI).

Cancer treatments

Some cancer treatments can cause an early menopause. These include:

surgery to remove the ovaries
radiotherapy to the pelvis
drugs that block or lower the amount of hormones in the body (hormone therapy)
chemotherapy

Your menopause might be temporary if it has been caused by some cancer treatments. For example, if you have chemotherapy and, or hormone therapy.

Your menopause is more likely to be permanent if you are closer to the natural age of menopause. Your doctor might be able to say whether your menopause is likely to be temporary or permanent. But this will be difficult to know for sure.

Some women have already been through the menopause. But their treatment can cause symptoms similar to the menopause.

Effects of early menopause

Early menopause due to cancer treatment can be a shock. It can feel physically and emotionally overwhelming. It can cause difficult symptoms as well as affect your sex life and sexuality.

A sudden menopause (due to treatment) can cause more severe symptoms than a natural menopause. The symptoms can last a number of years and they can change with time.

Menopausal symptoms

Symptoms include:

hot flushes
night sweats
anxiety, low mood and mood changes
feeling very tired (fatigue) and poor sleep
problems with thinking, concentration and memory – sometimes called brain fog
loss of interest in sex
joint pains and muscle aches and you may have thinning and weakening of the bones (osteoporosis) over time
headaches and worsening migraines
itching, irritation or dryness of your vulva or vagina
vaginal pain or discomfort during sex
vaginal bleeding after sex
urinary problems such as needing to wee urgently, infection or incontinence

Fertility

Your fertility Open a glossary item might also be affected and you may no longer be able to have children naturally. This loss of fertility can be upsetting even if you have a family or did not intend to have children.

Whether this happens to you depends on different factors. For example, your age and the cancer treatment you have had. Speak to your doctor if this is a concern for you. They can explain how likely this is in your situation.

Some women who have experienced an early menopause can still get pregnant. So you may still need to use contraception.

Who can I talk to about my menopausal symptoms?

It can be hard to know whether your symptoms are due to your cancer and its treatment. Or whether they relate to the menopause. It might help to keep a diary or make a list of your symptoms. You can discuss these with your cancer doctor, clinical nurse specialist, GP or general practice nurse.

You can ask your GP surgery if there is a GP that specialises in the menopause. In some situations, your GP may refer you to a specialist menopause clinic or a gynaecologist.

Hormone replacement therapy (HRT) and cancer

This information is for people who have cancer, or have had cancer. For people who don’t have cancer, and are looking for information about HRT visit our information:

Hormone replacement therapy (HRT) includes a range of medicines. They replace the hormones that your body used to produce naturally. They contain oestrogen, progesterone and, or testosterone. You have them as tablets, patches, gels or a spray.

There are different types of HRT, your doctor can explain the options available to you. The main types that reach the whole body (systemic) are:

oestrogen only HRT
combined HRT which includes oestrogen and progestogen

HRT can help to relieve symptoms of the menopause. And many women who have had cancer can take HRT. But doctors are more cautious in cancers that are simulated to grow by hormones. These are called hormone receptor positive or hormone dependent cancers.

Breast cancer

Your doctor may not routinely recommend that you have HRT if you have breast cancer. The concern is that HRT could increase the risk of your breast cancer coming back (recurrence). The risk for women who have had breast cancer is uncertain because research so far has not drawn any firm conclusions. This might depend on the type of HRT and how long you have it.

The risk is thought to be greater in women:

who have hormone receptor positive breast cancer
who take HRT that contains oestrogen and progestogen (combined HRT)

It’s important that you talk to a health professional if you are finding menopausal symptoms difficult to cope with. Ideally, you should speak to your cancer doctor as well as a doctor that specialises in the menopause.

Your doctor might suggest that you try other things first, such as non hormonal medicines. But they may offer HRT if your symptoms are severe. For example, if hot flushes or low mood, or a combination of symptoms are affecting your quality of life. Your doctor should discuss the risks and benefits of HRT with you.

Other hormone positive cancers

There are other cancers that are hormone receptor positive. So if you have one of these, your doctor might be more cautious when considering HRT for menopausal symptoms. These include:

advanced womb cancer that has oestrogen and progesterone receptors (oestrogen and progesterone receptor positive)
sarcoma of the womb that is oestrogen positive
a type of ovarian cancer called epithelial ovarian cancer, which is oestrogen and progesterone positive
other types of ovarian cancer called germ cell and sex cord stromal tumours

Talk to your doctor if your menopausal symptoms are severe. They can discuss the risks and benefits of HRT in your situation.

Cancers that are not hormone positive

There are many cancers that are not hormone positive (or not hormone dependent). In a few of these, research suggests that women should not take HRT, or the research is unclear. This is why it’s important to talk to your cancer doctor and GP. But HRT is an option for people with most types of cancer that are not hormone positive.

Depending on your age, your doctor might recommend you have treatment to replace the hormones you would normally produce. This might be the case even if you don’t feel that your menopausal symptoms are too bad. This might apply to if you:

have your menopause under 40 years – premature ovarian insufficiency
have an early menopause – usually between the ages of 40 and 45 years

You would normally take HRT until the natural age of your menopause. Some younger women can take the combined contraceptive pill to replace hormones, instead of HRT.

For younger women, the health benefits of hormone replacement generally outweigh the risks. For example, HRT or the combined contraceptive pill can help to prevent bone and heart problems that an early menopause can cause.

Again, it’s best to discuss your situation with your healthcare team.

Things that might help

There are a range of other treatments and things you can do to help cope with the effects of menopause. You may need to try different things before you find something that works for you. And you might find that a combination of things is better than one.

We have information about ways to cope with symptoms such as:

hot flushes and sweats
vaginal dryness and loss of interest in sex
problems sleeping
bone loss

Talking, time for yourself and getting support

It can be hard to come to terms with your diagnosis at the same time as having menopausal symptoms. It might help to talk to family and friends and share how your symptoms are making you feel with your family and friends.

Try to make some time for yourself. Some people practice breathing or relaxation techniques, or mindfulness. And some people find counselling and support groups helpful.

Work and menopausal symptoms

It might help to let someone in your workplace know if you are finding menopausal symptoms difficult. It makes sense to talk to your manager first, it might be useful if some of your colleagues know as well. This all depends on how comfortable you feel about sharing what you are going through. If possible, small adaptions to your work could help. For example, flexibility of your hours, positioning your desk near a window or nearer to the toilet.

Information is available about menopause in the workplace. You can find resources on government, trade union and charity websites.

Sharon's story

Sharon was diagnosed with breast cancer in 2016.

‘I’m still on medication… this causes early menopause that’s not been fun but coping well now.’