Breast Cancer and Menopause: Risks & Symptoms

In the UK, breast cancer is the most common cancer in females, where 1 in 7 women will be diagnosed with breast cancer in their lifetime1. That means that there is a significant number of women who will either enter menopause with a previous breast cancer diagnosis, or or will receive a breast cancer diagnosis during their postmenopausal years.

Navigating menopause and breast cancer alongside each other can be very challenging for patients. The good news is that there are many different options available. In this article, we explore menopause and breast cancer in tandem, explaining how they are linked and outlining how you can manage menopause symptoms if you have a history of breast cancer.

Menopause and breast cancer

It’s important to state that menopause does not cause breast cancer, but we know that the risk of breast cancer increases as we get older. Breast cancer is most commonly diagnosed in women over 50 (in 8 out of 10 cases2), but younger women can get breast cancer too.

There is no one cause for breast cancer, but there are certain factors that we understand impact on an individual's risk of developing a breast cancer including:

Age: The risk of breast cancer increases with age.
Family history: Most patients diagnosed with breast cancer do not have a family history of the disease2. However, if a patient's history suggests there could be an increased risk, your doctor will recommend a referral to the family history clinic. This can help explore an individual's personal risk and whether earlier mammogram screening or genetic testing is appropriate.
Weight: Being overweight or obese in postmenopause is a significant risk for breast cancer, with the risk becoming higher the more your weight increases. Postmenopausal women who are obese have a 30% higher risk of breast cancer compared to women of a healthy weight3. Keeping to a healthy weight can help reduce your risk of cancer.
Alcohol: Regularly drinking alcohol increases breast cancer risk.
Smoking: Smoking slightly increases breast cancer risk. Stopping smoking will not only reduce the risk of different types of cancer, but has other significant health benefits.
Diabetes: Although the reason why is not fully understood, having type 2 diabetes in post-menopause increases the risk of breast cancer3.
Periods: Starting your periods before the age of 12 has a small increased risk.
Menopause: A later menopause after the age of 55 slightly increases your risk of breast cancer.
Breast feeding: Breastfeeding slightly reduces your risk of breast cancer and is related to the length of time of feeding.
Taking HRT: There is a small increased risk of breast cancer with combined HRT which is thought to be related to the duration of use. Studies suggest combined HRT for more than 5 years may lead to a slightly increased risk. This may also depend on the type of HRT prescribed4.
Certain other breast conditions.

Having breast cancer itself doesn’t result in menopause, but the treatments for breast cancer can cause menopause or menopause-like symptoms.

Can breast cancer treatment trigger menopause?

Breast cancer treatment often causes women to enter menopause prematurely. This is because treatments can significantly impact hormone levels, potentially triggering menopause earlier than expected. While some women experience temporary menopause symptoms, others may face permanent changes, depending on the type and intensity of the treatment.

Chemotherapy

Chemotherapy can damage the ovaries, leading to a decline in their ability to produce hormones like oestrogen and progesterone. For some women, this causes temporary menopause, but for others, especially those closer to natural menopause, the effects may be permanent. This is dependent on the type of drugs, the dosage and the length of treatment5.

Find out more about medically induced menopause.

Surgery

An oophorectomy (surgical removal of the ovaries alone) or a total hysterectomy (removal of ovaries as well the womb) causes the immediate and permanent onset of menopause, as it eliminates the body's primary source of oestrogen and progesterone5.

Medications

Hormone therapies such as tamoxifen or aromatase inhibitors are often used in breast cancer treatment to block or lower oestrogen levels. These medications can induce menopausal symptoms. This may reverse after stopping the treatment, though the timeline varies6.

Menopause and benign breast conditions

Menopause can bring noticeable changes to a woman's breasts as hormone levels decline and the body transitions to a new phase of life. These changes are a natural part of ageing but can sometimes raise concerns, particularly when new lumps or sensations occur.

Most women's breasts become softer as glandular tissue decreases and is replaced by fatty tissue. This shift can make normal lumps more noticeable, as the density of the breast reduces7.

Some of the most common benign breast conditions found in perimenopause and menopause include fibroadenomas, breast cysts and fibrocystic change.

Any changes to the appearance of the nipples, or concerns about lumps should be reviewed with your GP.

Fibroadenomas

Fibroadenomas are non-cancerous breast lumps that are more common in younger women but can occur at any age. It is thought they may occur because of the effects of oestrogen.

They are generally smooth, rubbery, usually painless lumps that are movable under the skin. While fibroadenomas are benign and do not usually increase your risk of breast cancer, they should be monitored for any changes in size or feel, as hormonal shifts can sometimes affect their behaviour. Any new breast lump should be examined by your GP.

There are four types of fibroadenomas:

Simple fibroadenoma: About 1-3 cm in size and with a consistent appearance all over when looked at under a microscope. Simple fibroadenomas do not increase the risk of breast cancer in the future.
Complex fibroadenoma: Some cells have different features, and these can very slightly increase the risk of breast cancer developing.
Giant fibroadenoma: In some instances, a fibroadenoma can grow to more than 5cm although these most commonly develop during pregnancy and breastfeeding.
Juvenile fibroadenoma: These are found in teenage girls8.

Breast cysts

Breast cysts are fluid-filled sacs that are most commonly found in women over 35. They can develop or persist into menopause for women taking hormone replacement therapy. They are common benign causes of breast lumps that feel a bit like grapes and can be tender or painful. Most breast cysts do not need to be treated, and they may go away on their own9. Having a breast cyst does not increase your risk of breast cancer.

Fibrocystic changes

Fibrocystic change is a common benign (non cancerous) breast condition which does not increase your risk of breast cancer. The lumps can be caused by a mixture of thickened fibrous tissue in an area of the breast and fluid filled cysts and can make the breast feel lumpy, tender or painful. Fibrocystic breast changes are uncommon in post-menopausal women but can affect post-menopausal women on HRT. It is important to get any new breast change reviewed by your GP.

There are other types of breast conditions that may impact on breast cancer risk slightly differently. These can be discussed with a Menopause Specialist in more detail.

Does hormone replacement therapy increase breast cancer risk?

Hormone replacement therapy (HRT) does slightly increase the risk of breast cancer (as well as ovarian and sometimes womb cancer)11. However, the risk is small and depends on the type of HRT you take and the duration of use. In most instances the benefits of taking HRT outweigh the risks for most patients.

There is little to no increased risk of breast cancer when using oestrogen-only HRT. This type of HRT is usually only recommended to people who have had their uterus removed3.

Combined HRT, which uses both oestrogen and progestogen, may increase your breast cancer risk when used for more than five years. The risk reduces after you stop taking the combined HRT treatment, although if used for more than ten years, some risks will remain3.

Learn more about HRT and breast cancer in our guide.

What can I take for menopause after breast cancer?

If a patient has had breast cancer, it is usually recommended first line to avoid HRT, as there is concern that HRT can increase the risk of the breast cancer coming back (recurrence).

This can often be a really confusing and difficult time for patients with menopausal symptoms after a diagnosis of breast cancer. The decision to take HRT or not requires a very individualised assessment with your doctor; taking into account your medical history, type of cancer and treatment, impact of menopausal symptoms and lifestyle factors.

Fortunately there are other, non hormonal options to help with menopause symptoms. Let’s take a look at these.

Non-hormonal medications

Clonidine: This can help with hot flushes, especially in women taking tamoxifen, though it can cause side effects such as sleep disturbance, dry mouth, fatigue, nausea, headaches and dizziness. This needs to be used with caution in women who already take blood pressure medication.
Antidepressant medication such as Venlafaxine, Paroxetine, Fluoxetine, Sertraline and Citalopram. These medications can all have initial side effects including nausea, dizziness and short term initial anxiety as well as may impact on libido. Some antidepressants interact with tamoxifen.
- Venlafaxine: In terms of hot flushes, venlafaxine has the most convincing evidence of a positive outcome and it can also help with mood. It often needs starting a low doses due to dizziness side effects. There is no interaction with the cytochrome P450 enzyme so it may be the safest choice for patients on tamoxifen.
- Paroxetine and Fluoxetine: These can be useful in hot flushes and mood disturbance. Neither should be used with Tamoxifen as they can reduce its efficacy.
- Sertraline: Can help flushes and anxiety symptoms however not to be used with tamoxifen due to enzyme interactions.
- Citalopram: Helpful for mood symptoms and flushes. Less enzyme interaction with cyochrome P450 compared to other antidepressants such as sertraline, paroxetine and fluoxetine.
Oxybutynin: Taken at a low dose, this can be helpful with hot flushes. Side effects include dry mouth and nausea.
Gabapentin or Pregabalin: These can be helpful to reduce hot flushes, pain and mood disturbance. Side effects can include drowsiness at certain doses, dizziness, weight changes, nausea and gastric upset.
Fezolinetant (Veozah): This is a new medication available privately, which can be helpful for hot flushes and is generally well tolerated.

Vaginal moisturisers and lubricants

For women experiencing vaginal dryness, discomfort, or painful intercourse due to menopause, vaginal moisturisers and lubricants can provide effective, hormone-free relief.

Moisturisers provide longer-lasting hydration to the vaginal tissues and are typically applied regularly, while lubricants are used to reduce friction during intimacy.

Topical oestrogen creams

Low-dose topical oestrogen creams/pessaries may be considered for managing severe vaginal symptoms, even for women with a history of breast cancer15. These creams or pessaries deliver minimal amounts of oestrogen directly to the vaginal tissue, which limits systemic absorption and reduces associated risks.

Alternatives to help you manage menopause symptoms after breast cancer

In addition to non-hormonal medications, other approaches can help manage symptoms and improve overall well-being.

Lifestyle changes

Adopting healthy lifestyle habits can help ease menopause symptoms and contribute to your long-term health and wellbeing. These changes can include:

Eating a healthy, balanced diet
Optimising your sleep routine and getting plenty of rest
Regular exercise
Stopping smoking
Limiting alcohol
Reducing caffeine
Relaxing and stress-reducing practices such as meditation, yoga and thai chi15.

Cognitive behavioural therapy

Psychological therapies, including Cognitive Behavioural Therapy (CBT) for menopause can help manage the emotional and physical challenges of menopause.

One study found that group CBT significantly reduced hot flushes and night sweats and had additional benefits on mood, sleep and quality of life in women who had menopausal symptoms after breast cancer treatment16.

Holistic therapies

Holistic therapies offer a whole mind and body approach to managing menopause symptoms and there is evidence to suggest they can be a beneficial tool for women who have had breast cancer.

Holistic therapies may include:

Massage
Acupuncture
Reflexology
Hypnotherapy

Several small studies have found that hypnotherapy can reduce hot flushes with one study finding women reported being able to reduce hot flushes by 41-90%17.

Seeking support for menopause after breast cancer

It’s estimated that 75% of menopausal women do not seek medical advice or treatment19, but seeing a doctor for menopause can be incredibly beneficial, especially if you seek support from a menopause specialist.

All the doctors at Menopause Care have experience working with patients who have a history of breast cancer and/or a family history of breast cancer.

The doctors can advise you on the safe and effective options available for managing menopausal symptoms after breast cancer and take time to answer any questions you may have. The doctors support patients in their own informed decision making to develop a tailored individual treatment plan.

If you’d like help during this transitional life stage to focus on your well-being, book a consultation with a menopause doctor.

DisclaimerAt Menopause Care, we ensure that everything you read in our blog is medically reviewed and approved. However, the information provided is not meant to replace professional medical advice, diagnosis, or treatment. It should not be relied upon for specific medical advice.

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