Reviewed by: Generosa Grana, MD
Updated October 3, 2010
Menopause is the permanent end of your periods (menstrual cycle). When periods end, you are postmenopausal.
Even if you went through menopause naturally before treatment, you could have menopausal symptoms or changes again or more intensely than you did before. These changes are a side effect of hormonal treatments, including tamoxifen and aromatase inhibitors.
If you did not go through menopause yet, you are premenopausal or perimenopausal. In premenopause, your ovaries produce most of the estrogen in your body, and you have a regular period. In perimenopause, your body is preparing to stop the regular menstrual cycle. Your ovaries produce less estrogen. You may have periods once in a while, but they do not happen regularly. Breast cancer treatment can sometimes speed your permanent transition to menopause.
Even if you are premenopausal or perimenopausal, you may still have menopausal symptoms, with or without losing your periods. Your period could continue, or it could stop temporarily and return later.
Menopause changes the amount of estrogen in your body. Estrogen plays an important role in the body, keeping our skin soft and our bones hard. It prepares the body for intimacy and pregnancy.
When breast cancer treatment affects the amount of estrogen in your body, you may have side effects such as:
- Hot flashes and night sweats
- Vaginal dryness or tightness, causing troubles with intimacy
- Thinning of the bones (osteopenia)
- Mood swings
- Weight gain
- Dry hair and skin
Every woman is unique, and you may have some, none or many of these side effects. If your menopause happens after surgery to remove your ovaries or other reproductive organs—an immediate and complete menopause—the symptoms may be more severe.
Many women cope with these side effects, and you are not alone if they make you feel frustrated, sad or discouraged.
As a premenopausal woman with hormone-sensitive breast cancer, your doctor may recommend oopherectomy, or removing your ovaries, as part of your treatment. Oopherectomy will cause a surgically induced menopause.
Sometimes, chemotherapy can cause temporary or permanent menopause. You could also have short-term menopausal side effects without going through menopause.
Whether your symptoms are permanent or temporary depends on many factors, including your age when you begin treatment and the type of chemotherapy you receive. Studies show that the younger you are, and the further away you are from your natural menopause, the more likely your periods will return. If you have concerns about fertility, make sure to ask your doctors about your chemotherapy regimen.
Some chemotherapies are more likely than others to cause menopause or menopausal symptoms. These include:
- The combination therapy of Adriamycin, Cytoxan and Taxol (ACT)
- The combination therapy of Cytoxan, Methotrexate, Fluorouracil (CMF)
Chemotherapy works by killing rapidly dividing cancer cells. Follicles (egg-containing cells in the ovaries) divide rapidly, so they may also be killed or damaged by chemotherapy. When follicles are damaged, the ovaries work less well and can disrupt the menstrual cycle or cause menopausal side effects like hot flashes, night sweats and other symptoms.
Hormonal therapy works by stopping estrogen from binding to the estrogen receptor and carrying out its normal functions (with tamoxifen), or by preventing the body from making estrogen (with aromatase inhibitors). In either case, menopausal symptoms result because of a lack of estrogen function.
If you are premenopausal, hormonal therapies can cause sudden, temporary menopausal symptoms. Tamoxifen, the standard hormonal therapy for premenopausal women, prompts hot flashes by blocking estrogen receptors in the brain that control body temperature and other functions in the body. Medicines that suppress your ovaries, like leuprolide (Lupron) also cause temporary menopausal side effects.
Tamoxifen and other hormonal therapies can cause hot flashes and other menopausal side effects, even if you are postmenopausal. These can be uncomfortable and frustrating, especially if you have been through menopause before.
It is very important to talk with your providers to find methods to control or manage side effects, especially if you take hormonal therapy pills. These medicines are most effective at reducing the chances of recurrence if you take them every day. Also, for the quality of your day-to-day life, it is important that you be as comfortable as possible while taking these medicines.
Do not be embarrassed or shy about talking with your providers. They can suggest practical tips or even medicines to help improve these side effects. We also recommend you speak with other women who have gone through menopause. They may have great ideas you can bring to your doctor. Start by calling our Breast Cancer Helpline at (888) 753-LBBC (5222) to talk with a woman who has had breast cancer-related menopausal side effects.
There are many ways to manage or prevent side effects of menopause. Women respond differently to different strategies, so some of these may work for you and some may not. LBBC volunteers suggest these ideas:
- Avoid spicy food, greasy food, caffeine and alcohol. These types of foods and drinks can trigger hot flashes. Instead, increase your intake of whole grains, brown rice, lean protein and greens.
- Keep cool. Wear layers of light fabrics and keep a cold drink nearby.
- Sleep on cotton bed sheets and use fans or air conditioning while sleeping.
- Try complementary therapies like massage or acupuncture. Many women say complementary therapies help with hot flashes, stress and headaches.
- Ask your doctor about taking low doses of antidepressants or other medicines that may help relieve your symptoms.
- Exercise! Integrate 20 minutes a day into your daily routine.
- Maintain a healthy body weight.
- Use lubricants and moisturizers to lessen pain during intimacy. Your doctor can suggest safe options for you.
- Talk with your doctor about how side effects interfere with your life. Your provider could have other ideas not included on this list.