A range of different medications and therapies used to treat both primary and secondary breast cancer can lead to symptoms which are typically experienced during the menopause. This is the stage in a woman’s life when her ovaries stop releasing eggs, meaning they are no longer able to become pregnant. The ovaries also stop producing the hormone oestrogen and this leads to what are collectively described as the menopausal symptoms.
For women who have already been through the menopause, these symptoms may be familiar yet no less distressing. For younger women, their treatments may cause them to have an early menopause and experience some of these typical symptoms which are described below.
In this section
Hot flushes & night sweats
Many women experience hot flushes as a result of their treatment. This is due to a lowering of oestrogen levels in the body, which is what happens during the menopause. Hot flushes can range from mild, warming sensations in the face to waves of heat felt across the whole body, resulting in heavy sweating. They can occur frequently, affecting women’s ability to go about their daily lives. Hot flushes at night may be experienced as waking up in a cold sweat and can be very disturbing to sleep.
It is important to tell your doctor or nurse about your hot flushes. You should not feel that you have to struggle to manage them without support. There are lots of things you can do that may be able to help:
Some women find that certain things can trigger hot flushes. Identifying these things can help you to prevent or reduce the frequency of your hot flushes. Such triggers can include caffeine, alcohol and spicy food. Keeping a diary may help you to track anything that brings on or worsens your hot flushes.
There are lots of things that you can try to help manage your hot flushes;
- Wear loose fitting cotton clothing.
- Wear layers that you can remove easily.
- Try cotton sheets and layers of bedding rather than a heavy quilt. Silk pillow cases can also be cooling.
- Use a fan in the bedroom and carry a battery-operated fan during the day.
- Opt for cold drinks rather than hot drinks and always carry a bottle of water with you.
- Rather than eating three large meals a day, try eating little and often.
If you are finding that your hot flushes are interfering with your daily life and you are struggling to manage them, your doctor may be able to prescribe some treatments to help. These may carry their own side effects so it is important to weigh up the decision carefully with advice from your doctor or nurse.
Though evidence is varied, some women also find complementary therapies such as acupuncture can help to ease their hot flushes [1, 2]. Please see our section on Complementary therapies for further information.
Hormone therapies can cause changes in the uterus (womb) and vagina, leading to symptoms such as vaginal discharge, bleeding, itching and dryness. These are normal symptoms of hormonal therapy, though you should discuss any vaginal bleeding with your doctor or nurse.
Dryness in particular can lead to pain and discomfort, particularly during sex. If you feel comfortable doing so, you can ask your doctor or nurse about non-hormonal creams, gels or lubricants which can help to ease this. Otherwise, you can buy these over the counter from a chemist.
Vaginal dryness and irritation can also be symptoms of infection and thrush so if they continue, it is a good idea to see your GP in order to rule this out.
Vaginal dryness can be extremely sore and uncomfortable, regardless of whether or not you are sexually active. When applied regularly (every 2-3 days) over time, vaginal moisturisers such as ReplensMD and Hyalofemme can help to rehydrate the walls of the vagina, relieving dryness, itchiness and soreness.
Water-based lubricants can also be used to reduce pain and discomfort during sex. Some examples include KY jelly, Astroglide, Sylk and Pasante TLC. You may need to try a few before you find the one that works best for you, since come lubricants can cause irritation.
Hormonal vaginal treatments
Whilst there are some hormonal treatments, such as creams and pessaries, which can help to relieve vaginal dryness, these are not usually prescribed in breast cancer since they contain a small amount of oestrogen which may promote cancer growth.
Though it may feel embarrassing, you are not alone in experiencing these symptoms. If they continue to be a struggle, please speak to your doctor or breast cancer nurse, who will be very experienced in treating these symptoms and will be able to offer expert advice.
Loss of interest in sex
You may find that your sex drive is lower when undergoing treatment for secondary breast cancer. This can be difficult and upsetting for many women. You are not alone in experiencing his.
Some women find that in managing and treating other menopause related symptoms caused by treatment, such as hot flushes and vaginal dryness, their sex drive improves. Loss of interest in sex may also be related to worry and emotional distress so it is important to be open and honest with you partner about how you are feeling.
Your doctor (or, if you have one, your breast cancer nurse) will be able to offer support and advice in this area. They will be very used to discussing sexual health and well-being in relation to cancer and treatment so try not to feel embarrassed or worried about raising this. They may be able to suggest treatments to make having sex more comfortable or refer you to a counsellor or therapist.
Please also see our section on Relationships, sex & intimacy for further information.
Changes in mood
Dealing with menopausal symptoms on top of everything else that comes with a diagnosis of secondary breast cancer can be both physically and emotionally challenging. For some women, this can lead to mood swings, depression, anxiety and loss of body confidence and self-esteem, as well as difficulty concentrating and poor memory.
Feeling anxious is a very natural response to the uncertainty and loss of control that you may experience with a diagnosis of secondary breast cancer. This can in turn make menopausal symptoms worse. Anxious feelings can develop into panic attacks, which can be very frightening. If you are experiencing anxiety alongside low mood, this may also be linked to depression. It is important to recognise and seek support for anxiety as it can have a huge impact on your physical and mental health.
Alongside the physical symptoms of the menopause (such as hot flushes and vaginal dryness), some women also find that their mood can change very suddenly, from feeling happy and positive to very low or irritable. These mood swings may not last for a long time but they can be very overwhelming to deal with.
Some women find it helpful to share how they are feeling. This might be through discussing it with family, friends or their doctor or nurse. There are also a range of support groups which you can access, both in person or online. See our Signposting section to find support suited to you and your needs.
Alongside the various coping strategies for the symptoms you’re dealing with, you may find the following helpful for your mental health & well-being:
- Eat a balanced healthy diet.
- Exercise regularly, or as often as you feel able to.
- Get plenty of sleep & rest.
- Make time for relaxation, whether just a moment of quiet thinking or practising some yoga, tai chi or mindfulness.
If you continue to struggle with your mood, speak to your doctor (or, if you have one, breast cancer nurse). This is not a sign of weakness or failing to cope. They will be extremely experienced in helping many women like you in very similar situations and will have lots of suggestions to help. Please also see our information on low mood & anxiety, if you feel this might be relevant to you, and our section on Psychological well-being.
Going through the menopause, either naturally or as a result of cancer treatment, can cause you to have problems with your bladder and passing urine. The hormone oestrogen helps to maintain the health of the tubes that drain urine from the bladder (ureters and urethra) and the muscles that surround the bladder (the pelvic floor muscles).
As breast cancer treatments can cause there to be less oestrogen in the body (just as what happens when women go through the menopause), these tubes and may become less elastic and weaken. This can lead to problems such as urinary infections (water infection) and leakage of urine (urinary incontinence).
These can be very distressing to cope with and might seem embarrassing to discuss with your doctor or nurse. They will be very experienced in helping women to manage these problems however, so don’t struggle alone.
Aiming to drink 2-3 L of water each day (around 6-8 glasses) can help to prevent a urine infection. It may also help to pass urine before and after sex.
If you find that you are needing to pass urine more frequently than usual, are finding it painful to pass urine, have noticed your urine is cloudy or foul smelling, or have a high temperature, you may have a urine infection.
Please contact your hospital immediately as you may need antibiotics to treat this.
Urine leakage (incontinence)
Leakage of urine is something many women experience and it can happen due to a number of reasons. It may be a menopausal symptom, caused by a drop in oestrogen levels, or a symptom of a urine infection. Whatever the cause, though it might feel embarrassing to discuss, your doctor or nurse will be very experienced in helping women to manage this problem. They will be able to suggest lots of things to help, from treatments to pads and panty liners.
Strengthening your pelvic floor muscles by exercising them regularly can also help. The NHS website has guidance on how to perform pelvic floor exercises.
Women going through the menopause, whether naturally or a result of their cancer treatment, commonly describe feeling their heart beating quickly against the chest. This sensation is known as heart palpitations. They are sometimes experienced during a hot flush and are related to the change in oestrogen levels in the body.
Heart palpitations might also be experienced as a result of anxiety. If you are feeling stressed or worried when these happen, try taking some deep breaths or trying a relaxation exercise such as visualisation. Caffeine, alcohol and smoking can all act as triggers so it can be a good idea to cut down or avoid these things if you are experiencing heart palpitations.
They are usually harmless and should pass but they can feel very unpleasant. If you are experiencing heart palpitations, it is a good idea to mention these to your GP, doctor or breast cancer nurse, as they may wish to rule out any problems with your heart.
If you experience heart palpitations with any of the following symptoms, it is important to seek medical attention urgently by calling 999 or going to your nearest Accident & Emergency (A&E) department:
- Chest pain or a tightness in the chest
- Severe breathlessness
- Feeling dizzy or light headed
- Fainting or blacking out
Cancer treatment can affect the heart in a number of ways. The risk of treatment causing heart problems is increased for women who already have a heart condition, or a condition that increases the risk of heart problems e.g. high blood pressure or raised cholesterol.
Problems with the heart can be found years after starting cancer treatment. For women with secondary breast cancer, heart problems can be a ‘late effect’ of receiving treatment over a number of years. A late effect is a side effect of cancer or cancer treatment which occurs in the longer term i.e. years after being diagnosed with and starting treatment for cancer.
Certain chemotherapy drugs are associated with the potential for slight damage to the heart muscle. For women who have previously had primary (early stage) breast cancer, their treatment may have included a group of chemotherapy drugs known as anthracyclines (e.g. doxorubicin or epirubicin). These drugs in particular are linked to this problem. Because the damage is so slight, it may not be detected or cause an issue until many years later.
Previous treatment with radiotherapy to treat cancer in the left breast can also be associated with a very small risk of damage to the heart’s muscles and vessels. However, radiotherapy is now delivered in a way that is very targeted, meaning only a very small area of the heart will receive any radiation and the risk of damage is even smaller.
Targeted or biological therapies such as Trastuzumab (Herceptin) can also cause problems in the heart, though the risk is higher for women who already have a heart condition before starting treatment. This means that women with certain heart conditions are not usually offered Herceptin. Tests to check the health of your heart are usually done throughout treatment with this drug.
Treatments which cause you to experience an early menopause may put you at risk of heart problems, since the hormones oestrogen and progesterone, whose levels fall in the menopause, protect the heart.
There are many symptoms which can be associated with heart problems. However, they may be related to lots of things other than cancer treatment. If you experience any of these, it is a good idea to get them checked out with your GP and to let them know about any of your past or current cancer treatments:
- Feeling you heart beating quickly or irregularly in your chest (heart palpitations)
- Pain or discomfort in your chest
- Feeling increasingly short of breath e.g. when climbing the stairs
- Weakness or dizziness
- Swelling of the feet and lower legs
- Increasing tiredness
Things you can do to look after your heart
There are lots of things which you can do to reduce your risk of developing heart problems.
- Fruit, vegetables and fibre (e.g. wholegrain pasta, bread and oats).
- Oily fish and chicken
- Regular physical activity
Cut back on…
- Fatty foods
- Red meat and processed meats (e.g. sausages, ham & bacon)
Please see our Healthy living section for further guidance on living a healthy lifestyle with secondary breast cancer.
Disclaimer: on this website you will find self-management advice to help you to manage a range of mild symptoms and side effects of secondary breast cancer and its treatment. Please ONLY use this advice if you are currently participating in the LIBERATE study. Otherwise, please follow the advice of your own healthcare team.
- Deng G, Vickers A, Yeung S, Cassileth B. Randomized, controlled trial of acupuncture for the treatment of hot flashes in breast cancer patients. Journal of Clinical Oncology. 2007 Dec 10;25(35):5584-90.
- Hervik J, Mjåland O. Acupuncture for the treatment of hot flashes in breast cancer patients, a randomized, controlled trial. Breast cancer research and treatment. 2009 Jul 1;116(2):311.
- Macmillan: Menopausal symptoms – managing menopausal symptoms
- Breast Cancer Now: Menopausal symptoms and breast cancer
- Breast Cancer Now: Vaginal dryness caused by breast cancer treatment
- Macmillan: Relationships and sex
- British Heart Foundation: Ask the expert – heart palpitations
- NHS: Heart palpitations and ectopic beats
- Macmillan: Late effects of breast cancer treatment – effects on the heart
Page last updated: April 2020