Managing physical changes due to breast cancer

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Physical changes associated with cancer can be due to the cancer itself or side effects from various treatments. Not everyone has the same physical changes, but during and after your treatment you might experience:  

Talk to your healthcare team about any symptoms or side effects you experience, so that they can help you address them. 

After your treatment, it’s important to have follow-up visits to check whether the cancer has come back and discuss any symptoms or side effects you might still be experiencing.  

Read more about the physical changes you might face.  

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Body image

Breast cancer and its treatment can mean changes to the way a woman’s body looks and how she feels about her body.

Regardless of what treatments a woman has or how her body looks after treatment, she may feel differently about her body after treatment for breast cancer. Women may be unhappy with their body size or shape or about scars from surgery. This can affect a woman’s self confidence.

Some women worry about how their body changes will impact on relationships with others, especially intimate relationships. Others find that they love their body more after breast cancer, as they come to terms with what they have been through and realise that they have an inner strength that they didn’t recognise before.

Breast prostheses and breast reconstruction can improve a woman’s body shape after surgery and can help improve confidence. Some women who have lost their hair because of chemotherapy find that wearing a wig, turban or scarf can help them feel more confident while their hair grows back.

Breast cancer and menopause

Treatments for breast cancer can affect the age of menopause and can influence the available options for managing menopausal symptoms.

Early or premature menopause caused by breast cancer treatment can be managed successfully.

Menopause refers to a woman’s final menstrual period. Menopause occurs when a woman’s ovaries no longer produce eggs, which results in her periods stopping. It usually occurs between the ages of 45 and 55.

Menopause can cause a number of different symptoms and can increase the risk of other health conditions such as osteoporosis. Some women find that menopausal symptoms have little or no impact. For others, menopausal symptoms can be more severe and can affect their quality of life.

This section provides information about menopause caused by breast cancer treatments and describes what can be done to help manage the symptoms of early menopause.

Which treatments cause menopause?

Treatments for breast cancer can affect the ovaries in a number of ways. These effects can be temporary or permanent.

  • Temporary or permanent menopause can occur in women receiving chemotherapy given to reduce the chance of the breast cancer coming back or spreading.
  • Women with hormone sensitive cancers will usually be advised to take anti-oestrogen treatments such as tamoxifen, goserelin or aromatase inhibitors. These anti-oestrogen treatments will affect the ovaries and commonly cause menopausal symptoms for the duration of their use. When these anti-oestrogens are stopped, periods (and fertility) may return, but this is very difficult to predict.
  • Temporary menopause is more common among women who are younger than 35 at the time of treatment. If menopause is temporary, menstrual periods may return within 1 year of stopping treatment. Permanent menopause is more common among women who are 40 or older at the time of treatment. 
  • There is no reliable test to predict whether menopause will be temporary or permanent. Although normal menstrual periods may return once treatment finishes, menopause may be permanent, regardless of age.
  • Permanent menopause also occurs in women who have surgery to remove the ovaries, or radiotherapy to the ovaries.

Regardless of whether menopause is temporary or permanent, you may experience menopausal symptoms during treatment. Some women who have already gone through menopause also experience menopausal symptoms with certain treatments. For example, drugs such as tamoxifen, goserelin and aromatase inhibitors – anastrozole, letrozole and exemestane – can cause symptoms such as hot flushes. These symptoms usually stop once treatment finishes.

Which breast cancer treatments cause menopause?

The likelihood of breast cancer treatment causing menopause depends on the type of treatment and your age when treatment starts.

Surgical removal of the ovaries.  As part of breast cancer treatment, you may be offered surgery to remove your ovaries (oophorectomy). If you are pre-menopausal, removal of the ovaries will bring on permanent menopause and will cause a sudden and permanent drop in your hormone levels.

Radiotherapy to the ovaries.  You may be offered radiotherapy to your ovaries to stop your ovaries from working. This is different to having radiotherapy to the breast. Radiotherapy to the ovaries stops them from producing and releasing hormones and results in a permanent menopause.

Chemotherapy.  Many different chemotherapy drugs are used in the treatment of breast cancer. Not all chemotherapy drugs cause early menopause or menopausal symptoms. Chemotherapy treatments change all the time – and so too does the risk of early menopause or menopausal symptoms.

Hormonal therapies. Hormonal therapies (also called endocrine therapies) may be given to women who have hormone receptors on their breast cancer cells. Hormonal therapies work by blocking the action of oestrogen. Some hormonal therapies can cause menopausal symptoms in younger women. Examples of hormonal therapies include goserelin, tamoxifen and aromatase inhibitors. Hormonal therapies can also cause menopausal symptoms even in women whose periods stopped some years before they were diagnosed with breast cancer. 

Effects of breast cancer treatments on fertility

Some treatments for breast cancer can affect your fertility (your ability to have children).

Once your cancer treatment has finished there is no reliable test to find out if you can still become pregnant. If your periods stop for a year or more, it’s more likely that your menopause will be permanent. If your menopause is permanent, you will be unable to get pregnant naturally.

If being able to have children is important for you, speak to your treatment team about fertility and family planning before starting treatment for breast cancer. Your oncologist may suggest that you see a fertility specialist to discuss your options.

Contraception after breast cancer treatment

Treatments for breast cancer may reduce fertility temporarily or permanently. However, this does not mean it is impossible to become pregnant during or after treatment.

Contraception containing hormones, such as the oral contraceptive pill (‘the pill’), implants or injections, should generally not be used after breast cancer.  Therefore it’s recommended that you use non-hormonal forms of contraception, such as condoms, diaphragms, intrauterine contraceptive devices (IUDs) or male or female sterilisation if you don’t want to become pregnant. It’s still possible to catch sexually transmitted infections (STIs) after menopause. Condoms are the most effective way of protecting against STIs.

If you were pre-menopausal before breast cancer and you are sexually active, talk to a member of your health care team about suitable methods of contraception for you.

Stages of menopause

There are several stages of menopause outlined below.

  • Pre-menopause: 
    the time from the onset of menstrual periods (“menarche”) until the start of peri-menopause. Before menopause (pre-menopause), the ovaries release an egg each month. If you do not become pregnant, the lining of the womb breaks down leading to monthly menstruation (‘periods’). During pre-menopause, the ovaries produce three main hormones: oestrogen, progesterone and testosterone.​
     
  • Peri-menopause (the menopause transition): 
    the time from the onset of irregular periods or vasomotor symptoms (hot flushes and night sweats) until 12 months after the final menstrual period. During peri-menopause, menstrual periods become irregular and menopausal symptoms such as hot flushes may occur. The duration of peri-menopause varies in individual women. During this time hormone levels commonly change from the monthly patterns seen during the pre-menopause. Because many organs in the body including the uterus (womb), vagina, vulva, breast, bone, bladder, brain, and skin are sensitive to these hormones, this can cause a wide range of symptoms which may affect both physical and emotional wellbeing.
     
  • Menopause: 
    the final menstrual period. Eventually, menstrual periods stop completely (menopause) and the type and level of hormones produced by the body changes.
     
  • Post-menopause: 
    the time from 12 months after the final menstrual period. After menopause, the ovaries produce less oestrogen and no progesterone. Some oestrogen is still produced by other tissues, particularly in fat. Testosterone levels fall slowly from the mid 20’s onwards but can drop suddenly in women who have their ovaries removed before they have reached menopause.

Hormone production and menopause

The hormone changes that occur during peri-menopause and at menopause affect the body in different ways:

  • loss of oestrogen is the main cause of menopausal symptoms
  • loss of progesterone is unlikely to cause symptoms
  • loss of testosterone may affect sex drive (libido) and energy levels in some women.

Menopause can cause a number of different symptoms and can increase the risk of other health conditions such as osteoporosis (thinning or weakening of the bones).

Symptoms of menopause

Every woman’s experience of menopausal symptoms is different. The severity of symptoms can vary between different women.

For some women, the only symptom of menopause is that their monthly periods stop. Most symptoms of menopause are temporary and will ease with time.

Symptoms of menopause may affect your everyday life. You may find it helpful to keep a diary of your symptoms so that you can discuss them with a member of your health care team. View an example of a menopause symptom diary (pdf 55 kb).

This section describes some of the common symptoms of menopause and  includes suggestions about changes to your lifestyle that can help reduce symptoms and make them easier to manage. These suggestions  may not stop the symptoms completely. However, it’s worth noting that the lifestyle changes you put in place now may bring you other physical and psychological benefits in the future.

Irregular menstrual periods

If you’re experiencing menopause, your periods will stop.

They may first become irregular. Changes in the pattern of menstruation, usually less frequent, but heavy bleeding can also occur. For some women their periods may stop suddenly.

Coping with stress and emotional worries

Menopausal symptoms can be particularly distressing for younger women.

Most menopausal symptoms will resolve with time. However, for some women, the stress and emotional burden of menopause can be overwhelming

Remember, it’s ok to ask for help. You may find it helpful to tell those close to you about what is happening and how your symptoms make you feel. Support and understanding from others can help you manage your symptoms.

Mood changes

Emotional responses to menopausal symptoms vary greatly between women.

Younger women may have particular concerns about loss of libido, loss of fertility or a feeling of growing old prematurely. Sleep deprivation associated with night sweats can also result in moodiness and irritability.

Managing mood changes can be more of a challenge for women who are working or caring for young children. Recognising these symptoms and allowing time for self-care (‘time out’) can help.

If you’re experiencing feelings that are overwhelming you or interfering with your daily activities, talk to your treatment team.

Hot flushes and night sweats

Hot flushes are a side effect of many hormonal treatments for breast cancer and are common during menopause.

Hot flushes may come and go and are not always severe. The duration of hot flushes also varies between women. Some women may experience hot flushes for many years.

What helps ?

Although we don’t know how to stop hot flushes, there are some things you can do to help manage the symptoms:

  • wear natural fibres like cotton which absorb sweat
  • dress in layers, so that it’s easy to take off an item of clothing when you experience a hot flush
  • reduce your intake of caffeine, alcohol, hot drinks and spicy foods
  • keep a small fan in your work area and drink cold water to cool you down
  • keep a note of when you experience hot flushes and what you’re doing when they occur; this may help you identify the ‘triggers’ that cause your flushes and help you find ways to avoid them
  • consider yoga, meditation or relaxation techniques
  • consider other lifestyle strategies, such as a healthy  diet, regular exercise,  and not smoking. 

Staying cool in bed?

  • keep cold water by your bed ready to drink at the first sign of a sweat
  • use cotton sheets and cotton nightclothes
  • sleep under layers, so you can easily remove extra bed covers
  • have a small fan running to keep the air moving while you sleep.

If you think you would find it helpful to share your experiences with other women, you may like to join a support group. Meetings can be face-to-face or held over the telephone or internet.

Sexuality and libido

Menopause can cause a loss of libido, and can decrease your desire for sexual intimacy.

Managing these symptoms may require some effort – and open communication between you and your partner.

Some women say it takes longer to become aroused and experience orgasm during and after menopause. The loss of desire and libido may be directly related to lower levels of the hormones oestrogen, progesterone or testosterone. Vaginal dryness and pain may further increase the problem.

Changes in libido may not only be the result of your menopausal symptoms. Breast cancer and its treatment can influence your overall sense of femininity and sexuality. This can happen to any woman, whether or not she has a partner.

What helps?

There is a range of practical and lifestyle remedies that can help manage some of the effects of early menopause on sexuality and libido, including managing vaginal dryness.

  • Be open with your partner; explain what is happening and what might be helpful for you.
  • Relaxation techniques may help to reduce your stress levels and help you refocus on your relationship.
  • Treat vaginal dryness if it’s causing discomfort. 
  • Downplay the importance of sexual intercourse and orgasm, at least for a while. Instead, focus on the pleasure of touching, kissing, and imagery. Women may need foreplay to become properly aroused, so don’t hurry this aspect of your relationship, and let your partner know what helps.
  • You and your partner may find it helpful to talk to a health professional – you can do this together or separately. You may want to ask for advice from a trained specialist such as a relationship counsellor or sex therapist.
Vaginal dryness

Menopause can reduce the body’s production of the hormone oestrogen. Oestrogen is important for maintaining the moisture and elasticity (stretch) of the vagina. 

When oestrogen levels are lower, vaginal dryness and loss of vaginal elasticity can make sexual intercourse uncomfortable or painful. Unlike hot flushes, vaginal dryness does not improve with time and may be a long-term problem unless treated.

What to do about vaginal dryness?

The most effective solution for vaginal dryness is to use a product that will add moisture to the vaginal tissue. There are three types of vaginal moisturisers. All are applied directly into the vagina.

Non-hormonal vaginal moisturisers

Non-hormonal vaginal moisturisers provide relief from the uncomfortable symptoms of vaginal dryness. These products come in a semi- liquid form and are usually applied twice a week. They are available from most pharmacies.

Vaginal gels and lubricants

Vaginal pH-balanced gels are used to prevent and treat vaginal dryness. With a pH similar to that of normal vaginal discharge, these gels have been found to improve vaginal dryness and vaginal pH in women after breast cancer.

Vaginal lubricants provide lubrication to enhance the comfort and ease of sexual intercourse. If you use a vaginal lubricant choose a water-based or silicon-based lubricant rather than oil-based lubricants which may increase the risk of getting yeast infections. These products come as ‘semi-gel’ creams and are available from pharmacies.

Applying a gel containing a local anaesthetic to the area around the vulva immediately before sexual intercourse may reduce pain and discomfort associated with penetration.

Vaginal oestrogens

Vaginal oestrogens are creams, rings or tablets containing low doses of the hormone oestrogen that are inserted directly in the vagina. They are designed to help reduce symptoms associated with vaginal dryness and discomfort with sexual activity.

Small amounts of vaginal oestrogen may be absorbed into the body. For women taking aromatase inhibitors this may result in measurable increases in circulating oestrogens. The clinical significance of systemic absorption is uncertain, and for this reason some oncologists advise that some women avoid vaginal oestrogens after breast cancer. It has not been shown that vaginal oestrogens increase the risk of breast cancer recurrence or spread. Vaginal oestrogens should only be prescribed by a medical practitioner who is aware of your history of breast cancer and use of vaginal oestrogens should be discussed with your treatment team.

We don’t yet know whether vaginal oestrogens are safe after breast cancer. It is important to talk to your oncologist or general practitioner about your options.

Other ways of managing vulvovaginal dryness

Avoid substances that can irritate or dry the vaginal region, such as soap, or products containing alcohol or perfume. Products containing petroleum jelly and baby oil can also cause irritation. Use a soap-free product to wash the vaginal area.

Wear cotton underwear and avoid nylon underwear, tight underwear, or tight clothing.

If you’re sexually active, discuss your concerns with your partner. If your partner is aware of how you feel, they are more likely to help you explore alternatives.

Simple strategies, such as changing the position for intercourse, can relieve discomfort. Pain during sex can make you tense, and that tension can cause more pain. Try exploring alternative ways to be intimate so you and your partner can maintain a pleasurable and satisfying sexual relationship.

Insomnia and disrupted sleep

Many women experience disturbed sleep during menopause.

You may wake up sweating from a hot flush. Other common problems include repeated awakenings, difficulty getting back to sleep and difficulty falling asleep. Disrupted sleep can cause fatigue and tiredness. If this is causing tiredness during the day, or if you’re regularly waking up feeling anxious and worried, consider speaking with your GP or another member of your treatment team. They will be able to talk to you about techniques and treatments to help you sleep.

What can help?

There are a number of things that may help you sleep better.

  • Before bed, avoid caffeine-based drinks, alcohol, and other stimulants like cigarettes. Try a non-stimulating herbal tea like chamomile instead.
  • Use the bedroom for sleep only – no TV or written work (sex is fine!).
  • Establish a regular bedtime and waking routine – it’s OK to take short naps (no longer than an hour) during the day, but try not to rest for long periods.
  • Keep the bedroom cool.
  • Gently increase physical activity during the day – such as walking or swimming.
  • Try controlled breathing – deep slow abdominal breathing.
  • Consider a short-term mild sedative – a GP can provide a prescription.
Fatigue and tiredness

Feeling fatigued or constantly tired is a common symptom of menopause and is a side effect of treatments for breast cancer such as chemotherapy and radiotherapy.

During menopause, disrupted or reduced sleep is the major cause of fatigue and tiredness. Regardless of what is causing your tiredness, exercise may help reduce the symptoms.

What can help?

  • Establish a gentle regular exercise program, increasing your level of activity gradually and varying the exercise so you don’t get bored.
  • If you haven’t exercised for a while or have other medical conditions, ask your general practitioner about the type and amount of exercise you should undertake.
  • Ask a friend to exercise with you to help keep you motivated.
  • If you’re experiencing significant fatigue, take on a small activity, followed by a rest period, followed by another activity.
  • Avoid long periods resting in bed; it will only increase your fatigue.
  • Eat a diet that includes at least 5 serves of vegetables and 2 serves of fruit a day.
  • Drink enough water (about 8 glasses a day is recommended) so that you do not feel thirsty. Dehydration can also be the cause of fatigue.
Effects on memory

Menopause does not cause you to lose your memory.

However, changes in sleep pattern, tiredness, depression and anxiety can cause you to become forgetful and may impair your mental functioning.

What can help?

  • Make lists of things that are important to remember.
  • Stay mentally active—try a crossword, Sudoku or quizzes.
  • Keep a brief diary of appointments and things to do and check it regularly.
  • Regular exercise can help improve your sleep patterns and your mood.
  • Explain to your family and friends what is happening to you so they can help and give you support.
Bladder problems

Bladder problems – such as incontinence (urine leakage), passing urine more frequently at night and urinary tract infections – can become more common during menopause. 

If you experience a burning pain when passing urine, or if you feel the need to go to the toilet frequently yet pass only small amounts of urine or the urine smells unpleasant, see your general practitioner. You may have a bladder infection that requires treatment with antibiotics.

What can help maintain bladder health?

  • Drink sufficient fluids – especially early in the day.
  • Go to the toilet promptly when your bladder is full.
  • Pass urine directly after intercourse.
  • Wipe from front to back after using the toilet.
  • Talk to your doctor about topical oestrogen.

What can help avoid incontinence?

  • Try pelvic floor exercises to reduce urine leakage and improve bladder control. Exercise brochures are available from most general practitioners and chemists. You may find it helpful to seek advice from a physiotherapist - ask your general practitioner or breast care nurse for a referral.
  • Keep your weight within normal limits for your height.
  • Avoid stimulants for coughing, like cigarettes
  • Avoid food and drinks containing high levels of caffeine, as this can irritate the bladder and can increase incontinence.
  • Visit your local continence advisory service. Ask your general practitioner or breast care nurse for more information.
Bone and joint pain

Painful joints can be a problem associated with menopause, and can also be a side effect of drugs used to treat breast cancer, such as aromatase inhibitors. Sometimes joints can feel stiff and sore.

What can help?

  • Exercise can help to maintain a range of movement and maintain a healthy weight. You can speak to an exercise physiologist about what exercise would be good for you.
  • You may wish to talk to a dietitian and ask about recommended diet or vitamin supplements. 
  • Talk to your general practitioner if you have bone or joint pain to check that you don’t have other joint changes, such as arthritis.
Putting on weight

Weight gain is common during both cancer treatment and menopause.

Maintaining a healthy weight is an important aspect of a long-term health for cancer survivors. There are many ways to avoid weight gain, and to lose additional weight if you put it on. Talk to your general practitioner, breast care nurse or ask to speak to a dietitian for advice.

Talk to your general practitioner, breast care nurse or ask to speak to a dietitian for advice. 

What can help avoid weight gain?

  • Eat a healthy diet, including lots of fresh fruit and vegetables.
  • Reduce your intake of foods with saturated fat, added salt and added sugar.
  • Drink more water and less sugary liquids like soft drink and fruit juice.
  • Participate in regular physical activity, aiming for at least 30 minutes of moderate-intensity activity every day, and limiting sedentary habits (the time you spend sitting or lying down).
  • If you choose to drink alcohol, limit your intake.
  • You can get detailed advice on your particular needs from a dietitian.
  • To find an accredited dietitian near you
Self care

Some women find it helpful to take ‘time out’. 

This can mean enjoying a long bath, a massage, weekends away with loved ones, or a long walk in a favourite environment. Taking care of yourself is not being selfish. The relaxation it brings can reduce stress levels and help you to cope. 

Treatments for menopausal symptoms

For some women, menopausal symptoms can be severe and can have a significant impact on their lifestyle.

Your decision about whether to use a treatment for menopausal symptoms will depend on the severity of your symptoms and the potential effect of treatment on your risk of breast cancer coming back.

Relatively few studies have looked at how menopausal symptoms can be treated safely after breast cancer. This section provides an overview of the common medical treatments used in managing menopausal symptoms, and discusses what is known about their use in women after breast cancer.

Talk to your oncologist  or your GP about your options before making a decision. You may also find it helpful to talk to a menopause specialist about the treatments that are safe and effective for you.

Non-hormonal treatments for menopausal symptoms

There are non-hormonal treatments that have been shown to be effective in the management of menopausal symptoms. 

Below is a list of the most common treatments and their side effects.

Venlafaxine and other similar antidepressants

There is now good evidence that selected antidepressants (at doses lower that those used to treat depression) can improve menopausal symptoms after breast cancer. The antidepressants that have been shown to lead to fewer and less severe hot flushes are venlafaxine, desvenlafaxine, paroxetine, and escitalopram. In addition, low doses of venlafaxine can also improve mood, and low doses of desvenlafaxine and paroxetine can also improve sleep.

Generally these antidepressants are used in low doses to treat menopausal symptoms, and side effects are less common than at higher doses. However, side effects can include nausea, decreased appetite, dry mouth, constipation, and decreased libido.

Some of these drugs, particularly paroxetine, may interfere with the way that your body breaks down tamoxifen and change its effectiveness. If you are taking tamoxifen, talk to your oncologist or general practitioner before starting treatment with antidepressants.

Ask your doctor for more information about these drugs.

Zolpidem

Zolpidem is a prescription medication used to treat insomnia. When added to venlafaxine (or other similar antidepressant drugs above) it may improve sleep and quality of life. Side effects of zolpidem can include sleep walking, sleep driving and other potentially dangerous sleep-related behaviours. Treatment with zolpidem may also interfere with your concentration in the morning, such as when driving.

Ask your oncologist for more information.

Gabapentin

Gabapentin is a drug used to treat chronic pain and epileptic fits. Studies have shown that Gabapentin can lead to fewer and less severe hot flushes, improved sleep and improvements in anxiety and mental health for some women.

Many women find gabapentin acceptable to use. However, up to half of the women who use gabapentin experience side effects including sleepiness, light-headedness, and dizziness. These side effects may resolve with time or can be reduced by adjusting the dose.

Clonidine

Clonidine is a drug used to treat high blood pressure. It can be used to reduce menopause-associated hot flushes after breast cancer, but has been found to be less effective than other treatments such as venlafaxine. Side effects of clonidine include a dry mouth, constipation, dizziness, itching, blurred vision, and sleep disorders or restless sleep.

Cognitive behavioural therapy

Psychological therapies such as cognitive behavioural therapy (CBT) aim to help you change your thought patterns to be more helpful and healthy. Studies in women who have had breast cancer have shown that CBT may improve hot flushes, sleep and sexual function.

Hormone treatments for menopausal symptoms

Menopause hormone therapy

Menopause hormone therapy, also known as hormone replacement therapy, (HRT) is a very effective treatment for menopausal symptoms. Menopause hormone therapy treatments are made up of the hormones oestrogen and progestogen, either individually or combined.  Some studies have shown an increased risk of breast cancer coming back (recurrence) following treatment with menopause hormone therapy, so it is generally not recommended after breast cancer.                                    

Menopause hormone therapy is generally avoided for women who have had breast cancer because it may increase the risk of breast cancer coming back. It is important to talk to your oncologist or general practitioner about your options.

Tibolone treatment

Tibolone is another drug used for treating menopausal symptoms. The drug acts in a similar way to menopause hormone therapy and research has shown an increased risk of breast cancer coming back (recurrence) following treatment with tibolone.

Tibolone is avoided after breast cancer because it may increase the risk of breast cancer coming back. It is important to talk to your oncologist or general practitioner about your options.

Testosterone treatment

Testosterone is produced by women as well as men. Testosterone levels fall gradually with increasing age and may be reduced by some breast cancer treatments. For some women, reduced levels of testosterone may lead to lower libido and lower energy levels. The safety and long-term effects of testosterone treatments have not been established.

Testosterone is not recommended for women who have had breast cancer. It is important to talk to your oncologist or general practitioner about your options.

Compounded or ‘bio-identical’ hormones

Compounded hormones, also known as ‘bio-identical hormones’ are hormonal preparations that are individually prepared for the treatment of menopausal symptoms or other hormonal complaints. Compounded hormone mixtures are prepared as troches (placed in the mouth) or creams (rubbed on the body). Compounded hormone preparations require a doctor’s prescription and are made up by chemists called compounding pharmacists.

Studies of compounded hormone creams have found inconsistent results and their safety after breast cancer is not known. Compounded hormone treatments can contain high levels of hormones and may increase the risk of breast cancer coming back.  

Compounded hormones are not recommended for women who have had breast cancer. It is important to talk to your oncologist or general practitioner about your options.

Ineffective therapies

There is no consistent evidence to indicate that the following therapies are effective in reducing menopausal symptoms:

  • Black cohosh
  • Homeopathy
  • Magnetic therapy
  • Omega-3 supplementation
  • Phytoestrogens and isoflavones
  • Vitamin E

The safety of these therapies after breast cancer is unknown. In particular, the side effects of black cohosh include gastro-intestinal upsets and skin rash. There are also concerns about the safety of black cohosh after reports of liver damage.

Other 'over-the-counter' or herbal remedies

There is a wide range of ‘over-the-counter’ medications or herbal remedies available for the management of menopausal symptoms. 

Examples include Dong Quai, evening primrose, ginseng, red clover and Chinese herbal preparations. There is very little evidence about the effectiveness or safety of over-the-counter menopausal remedies and very little is known about their effects in women who have had breast cancer.

Although plants and herbs are natural, this doesn’t always mean they are safe. Some herbs can interfere with cancer treatments by making them less effective or by increasing side effects. Some herbal preparations may contain oestrogen-like compounds that may increase the risk of breast cancer coming back.

If you are considering using any ‘over-the-counter’ or herbal preparations you should discuss them with your doctor first.

Memorial Sloan Kettering Cancer Center in the USA has developed a database called About Herbs with information about herbal therapies and supplements. To access this information go to www.mskcc.org. Please note that this is an American website and not all of the products listed maybe available in Australia.

Health effects of early menopause

For women in their 50’s, menopause is a normal event. Most women adjust to the physical changes with little if any impact on their quality of life, or activities. 

Most symptoms associated with menopause are resolved with time.

Most information about the effects of early menopause on health comes from studies of women who have had a natural early menopause. Only a few studies have looked at the effects of premature or early menopause on long-term health. It is not known whether the effects are the same in women who go through early menopause because of breast cancer treatment. This section provides a brief guide to the findings to date.

Heart disease

Premature or early menopause may increase the risk of heart disease. This means that exercise, weight control, treatment for high blood pressure, a balanced diet, not smoking and minimising alcohol intake are likely to be very important in women experiencing early menopause.

Osteoporosis

Loss of oestrogen at menopause may increase the risk of osteoporosis (thinning or weakening of the bones). The risk of osteoporosis can be increased further by some breast cancer drugs such as aromatase inhibitors.

Women with a family history of osteoporosis, who smoke, are underweight, have hyperthyroidism or have taken steroids are at particular risk of osteoporosis.

Hormonal therapy for breast cancer may also affect bone health. In general, tamoxifen maintains bone and reduces fracture risk and aromatase inhibitors decrease bone strength and increase fracture risk. Your doctor may measure your bone density if you’re at increased risk of osteoporosis before prescribing a hormonal therapy for you. If you’re already at increased risk of osteoporosis, your doctor will consider this when recommending which hormonal therapy is suitable for you. If you are concerned about your bone health you can discuss this with your oncologist when you start hormonal therapy. 

How can I reduce my risk of osteoporosis?

There are a number of effective strategies for avoiding osteoporosis including:

  • a balanced diet that contains enough calcium (1,200 mg/day) — a glass of milk or small tub of yogurt has about 250mg of calcium
  • adequate Vitamin D, this means taking Vitamin D supplements or being in direct sunlight for 5–15 minutes 4– 6 times a week, this may vary depending on where you live and what time of year it is.
  • not smoking
  • limiting alcohol intake.
  • doing regular weight-bearing exercise, for example walking, playing tennis or dancing, for at least 30 minutes, 2–3 times a week*
  • resistance training, such as exercise with weights*.
  • treatments are available that can improve bone strength. Talk to your doctor about how to reduce the risk of fractures and maintain bone strength.

*Talk to a health professional before starting any new activity after treatment for breast cancer, and build activities slowly.

Questions to ask about breast cancer and menopause

Listed below are some questions that may be helpful when talking about menopause and breast cancer:

  • What’s the risk that the treatments you are recommending for me will cause early menopause?
  • How soon after treatment starts should I expect menopausal symptoms, if any?
  • What level of menopausal symptoms is normal?
  • Will my periods stop as a result of my treatment?
  • I am planning a first or further pregnancy. Can I speak to a fertility specialist before starting treatment for breast cancer?
  • What contraception should I/my partner be using? For how long should I use contraception?
  • Can you refer me to a menopause specialist to discuss my symptoms and how they affect me and my family?
  • Apart from menopause, what else might be causing my symptoms?
  • Can I talk to someone about how I’m feeling?
  • Can I speak to a dietitian?
  • What level and types of exercise are suitable for me?
  • How will menopause affect my sex life?
  • What products can I use to help manage vaginal dryness?
  • Can I/my partner speak to a sexual therapist/counsellor?
  • What treatments are available if I have severe menopausal symptoms?
  • What’s known about the effectiveness of the treatment you are recommending?
  • Will the treatment you’re recommending affect my risk of breast cancer coming back or developing a new breast cancer?
  • Does the treatment you are recommending contain hormones or compounds that act like hormones? How do you know that this is safe for me to take after breast cancer?
  • What’s known about the long-term effects of the treatment you’re recommending?
  • Will this treatment affect my risk of osteoporosis? Can this be monitored?

Where to find more information about breast cancer treatment and menopause

In addition to the information you receive from your treatment team, you might find it helpful to get information from different sources. 

The organisations below are a good starting point.

Cancer Council Helpline is a free confidential telephone and information support service. Specially trained staff are available to answer your questions about cancer and offer emotional and practical support. Call 13 11 20 from anywhere in Australia

Breast Cancer Network Australia works to ensure that Australians affected by breast cancer receive the very best support, information, treatment and care appropriate to their individual needs. The BCNA website has information on health and wellbeing after breast cancer, including information on sexual wellbeing. Visit www.bcna.org.au

The Jean Hailes Foundation for Women’s Health translates the latest research findings into practical health and lifestyle approaches for women and their health professionals. The website also includes information about early menopause and managing menopause. Visit www.jeanhailes.org.au

The Australasian Menopause Society provides professional and consumer information about menopause. Visit www.menopause.org.au

Osteoporosis Australia is a research and advocacy group providing news about latest developments about osteoporosis. Visit www.osteoporosis.org.au

Effects of breast cancer treatments on fertility

Some treatments for breast cancer can affect your fertility (your ability to have children).

Effects of breast cancer treatments on fertility

Once your cancer treatment has finished there is no reliable test to find out if you can still become pregnant. If your periods stop for a year or more, it’s more likely that your menopause will be permanent. If your menopause is permanent, you will be unable to get pregnant naturally.

If being able to have children is important for you, speak to your treatment team about fertility and family planning before starting treatment for breast cancer. Your oncologist may suggest that you see a fertility specialist to discuss your options.

Surgery or radiotherapy to the ovaries and fertility

Surgery and/or radiotherapy to the ovaries causes permanent infertility.

If a woman has her ovaries removed by surgery, or if she has radiotherapy to the ovaries, she will no longer be able to have children naturally.

Chemotherapy and fertility

Some chemotherapy drugs can cause a woman to become infertile.

Some women (usually women under 35 years) find that their periods return once chemotherapy finishes. However, this doesn’t mean that they are able to have children.

The effect of chemotherapy on fertility depends on a number of things, including the woman’s age and the type of drugs she receives. These effects can also vary between different women of the same age.

Hormonal therapies and fertility

Treatment with hormonal therapies (endocrine therapies) doesn’t cause infertility. However, a woman’s fertility may fall naturally while taking hormonal therapies. Most hormonal therapies for breast cancer are given for 5 years. After 5 years, a woman’s fertility will have fallen naturally because she’s older.

Although hormonal therapies for breast cancer can cause menstrual periods to stop, this doesn’t necessarily mean that a woman can’t become pregnant while taking hormonal therapies. Women who are sexually active while taking tamoxifen should use effective contraception if they don’t wish to become pregnant during this time.

Treatments for breast cancer may reduce fertility temporarily or permanently. However, this doesn’t mean it’s impossible to become pregnant during or after treatment.

Contraception after breast cancer treatment

Treatments for breast cancer may reduce fertility temporarily or permanently. However, this does not mean it is impossible to become pregnant during or after treatment.

Contraception containing hormones, such as the oral contraceptive pill (‘the pill’), implants or injections, should generally not be used after breast cancer.  Therefore it’s recommended that you use non-hormonal forms of contraception, such as condoms, diaphragms, intrauterine contraceptive devices (IUDs) or male or female sterilisation if you don’t want to become pregnant. It’s still possible to catch sexually transmitted infections (STIs) after menopause. Condoms are the most effective way of protecting against STIs.

If you were pre-menopausal before breast cancer and you are sexually active, talk to a member of your health care team about suitable methods of contraception for you.

Although some breast cancer treatments can cause menstrual periods to stop, this doesn’t necessarily mean a woman can’t become pregnant during treatment. It’s important for women who are sexually active to continue to use contraception during and after breast cancer treatment.

There’s no evidence about whether or not it’s safe to take the oral contraceptive pill (‘the pill’) or use implants (etonogestrel implants) during or after treatment for breast cancer. Therefore it’s recommended that women use non-hormonal forms of contraception, such as condoms, diaphragms, intrauterine contraceptive devices (IUDs) or male or female sterilisation.

It’s still possible to catch sexually transmitted infections (STIs) after menopause. Condoms are the most effective way of protecting against STIs.

Breast cancer treatment and pregnancy

Some breast cancer treatments are not recommended for women who are pregnant when diagnosed with breast cancer. Some treatments can also affect a woman’s ability to have children in future.

Treatment for breast cancer during pregnancy

If a woman is pregnant when she is diagnosed with breast cancer:

  • it’s possible to have breast surgery with only a slight risk of miscarriage; the risk of miscarriage is lower after the first trimester
  • radiotherapy is not recommended because it may harm the unborn baby; radiotherapy can be given after the baby is born
  • chemotherapy is not recommended during the first trimester because it may harm the unborn baby; chemotherapy is often given during the second and third trimesters, when the risk of harm is lower
  • hormonal therapy and trastuzumab (Herceptin®) are not recommended.

Pregnancy during treatment for breast cancer

It’s recommended that women do not become pregnant during treatment for breast cancer. Treatments such as chemotherapy and radiotherapy can harm the unborn baby.

Women should use contraception if it’s possible that they could become pregnant during treatment, even if periods become irregular or stop during treatment.

Effects of breast cancer treatment on fertility

Some treatments for breast cancer can affect a woman’s fertility. Once treatment has finished there’s no reliable test to find out if a woman will be able to fall pregnant in future.

Women who were planning to have children before their breast cancer diagnosis should speak to their oncologist before starting treatment for breast cancer. It may be possible to see a fertility specialist to discuss the available options.

Lymphoedema

This section is for people who have lymphoedema or who are concerned about developing lymphoedema following treatment for cancer. It also contains information for health professionals, including resources for professional development workshops.Lymphoedema

Lymphoedema is a chronic swelling in part of the body that occurs because of a build-up of fluid in the body's tissues. Estimates suggest that about 20% of patients treated for melanoma, breast, gynaecological or prostate cancers will develop lymphoedema. There is no cure, but appropriate management and daily care can reduce swelling, improve movement and prevent infections.

The resources and information in this section aim to improve the knowledge and management of metastatic lymphoedema following cancer treatment. We hope that you find this information useful.

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