This page discusses the treatment of menopausal symptoms for breast cancer survivors.
Some information may also be helpful for women who have never been diagnosed with breast cancer.
Common menopausal symptoms in breast cancer survivors include:
There are different types of menopausal hormone therapy (MHT) used to relieve menopausal symptoms. Some are pills, some are used vaginally and others are patches (similar to a nicotine patch).
Oral MHT is usually not recommended for breast cancer survivors because findings from randomized controlled trials have shown MHT use increases the risk of [51-52]:
Learn about oral MHT and breast cancer risk in women who have never been diagnosed with breast cancer.
For a summary of research studies on oral MHT therapy and breast cancer recurrence, visit the Breast Cancer Research section.
Vaginal hormone therapies do not appear to increase the risk of breast cancer [53-56,212].
However, some of these therapies may increase blood estrogen levels [57-58]. If your breast cancer was hormone receptor-positive, vaginal estrogen rings and suppositories are preferred over vaginal estrogen creams .
Talk with your provider about whether these products may be safe options for you.
Whether hormone patches affect breast cancer recurrence (or breast cancer risk) is under study.
Treatment options for vaginal symptoms and hot flashes are discussed below. Some contain hormones and others do not.
Talk with your health care provider about the best methods for you.
One of the most common symptoms of menopause is vaginal dryness, which can cause pain during intercourse, vaginal soreness and itching.
Breast cancer survivors have options for the relief of vaginal dryness. Talk with your health care provider about which option is best for you.
Hormonal options for the relief of vaginal symptoms include:
Vaginal estrogen rings and suppositories may slightly increase blood estrogen levels, but for only a short time [57-58].
Creams may slightly increase blood estrogen levels for a longer time . If your breast cancer was hormone receptor-positive, vaginal estrogen rings and suppositories are preferred over vaginal estrogen creams .
Talk with your provider about whether these products may be safe options for you. All require a prescription.
A non-hormonal option for vaginal symptoms is an estrogen-free vaginal moisturizer (such as Replens or Hyalo Gyn).
These products are different from vaginal lubricants (such as K-Y Jelly and Astroglide), which only make the vaginal area slippery, rather than moisturized.
Moisturizers need to be used regularly (several times a week), rather than just around the time of intercourse. Since they don't contain estrogen, they're safe for breast cancer survivors.
Vaginal moisturizers are available over the counter (without a prescription).
Talk with your provider about the benefits and risks for each of these options.
The drug ospemifene (Osphena) is FDA-approved for postmenopausal women who have pain during intercourse due to vaginal dryness.
However, because ospemifene has some hormonal effects, it's not currently recommended for breast cancer survivors.
The pain-relieving drug lidocaine may be helpful for breast cancer survivors who have pain during intercourse due to vaginal symptoms.
One small study of survivors found that a compress of lidocaine to the vaginal area eased pain during intercourse . This helped make sex comfortable again for most women in the study .
Talk with your provider about this option and the correct way to apply the medication.
Breast cancer survivors who go through early menopause due to treatment may have hot flashes and night sweats. These women may have worse symptoms than those who go through menopause at later ages.
Hot flashes can also be a side effect of hormone therapy.
Ways to relieve hot flashes in breast cancer survivors are under study. These include:
Figure 6.2 below gives a summary of some of the non-hormonal medications studied for the treatment of hot flashes and other menopausal symptoms.
Among the most promising medications for treating hot flashes are 2 groups of anti-depressants called selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs).
SSRI and SNRI anti-depressants have been shown to decrease the frequency and strength of hot flashes by 50-60 percent, with few side effects [60-65].
Tamoxifen is a hormone therapy drug. Some SSRI anti-depressants (such as fluoxetine, paroxetine and sertraline) can interfere with the metabolism of tamoxifen (how tamoxifen works in the body) .
However, it's not known whether these drugs might affect tamoxifen treatment for breast cancer.
If you are taking tamoxifen, talk with your health care provider about possible drug interactions and other options for treating hot flashes.
A few studies have shown gabapentin (Neurontin), a drug used to treat seizures and pain, may greatly reduce hot flashes [67-70].
At high doses, the drug megestrol acetate is used to treat metastatic breast cancer. At these high doses, it can cause side effects, such as blood clots or weight gain.
In low doses, megestrol acetate may reduce hot flashes in breast cancer survivors . However, the safety of lower doses in women with early breast cancer has not been proven.
To date, there's little evidence vitamins and plant-based remedies reduce hot flashes in breast cancer survivors.
Figure 6.2 below gives a summary.
Although one small, randomized controlled trial found vitamin E slightly reduced hot flashes, most studies have not shown this benefit [68,72].
In randomized controlled trials, women (including breast cancer survivors) who took soy or black cohosh were no less likely to have hot flashes than those who took a placebo [73-78].
Although these studies did not show any harmful side effects of soy or black cohosh for breast cancer survivors, there are no long-term safety data.
Learn more about soy and breast cancer risk.
It's important to talk with your health care provider before taking any of the medications or remedies in the table below.
Summary of Evidence from Randomized Controlled Trials
Short-term Health Risks
Long-term Health Risks
Some evidence of:
No benefit over placebo for hot flashes
Strong evidence of:
In rare cases:
Should not be used long-term
May interact with tamoxifen
May have withdrawal symptoms if stopped too quickly
Strong evidence of:
Some evidence of:
May have withdrawal symptoms if stopped too quickly
Cannot be used long-term
Vegetable or plant-based remedies
Chinese herbal medicine
Dong quai root
Can interact with warfarin and lead to bleeding problems
Evening primrose oil
May worsen some types of epilepsy
Most studies report no benefit over placebo for hot flashes or vaginal dryness
Omega-3 fatty acid
Red clover extract
Most studies report no benefit over placebo for hot flashes or vaginal symptoms
Breast cancer survivors should discuss taking high doses of soy with their health care providers
Adapted from the North American Menopause Society and selected studies [60-65,67-87].
Small randomized controlled trials have studied whether acupuncture can reduce hot flashes in breast cancer survivors and other women.
Studies compared the benefit of true acupuncture to sham (fake) acupuncture. With sham acupuncture, the needles are placed at non-acupuncture points on the body.
Some findings showed acupuncture reduced hot flashes more than the sham treatment, while others found no difference between the two [88-92].
At this time, data are too limited to draw conclusions on the benefit of acupuncture for the relief of hot flashes in breast cancer survivors. This topic is still under study.
Cognitive behavioral therapy is a special type of mental health counseling. Group sessions are led by a mental health provider (such a psychologist or social worker) and may include techniques such as relaxation exercises.
A few, small randomized controlled trials have studied whether cognitive behavioral therapy can ease menopausal symptoms in breast cancer survivors. Some findings have shown it may decrease hot flashes for breast cancer survivors [87,93-94].
Cognitive behavioral therapy is also under study for reducing fatigue and insomnia in breast cancer survivors.
At this time, few people are trained to give cognitive behavioral therapy and it’s not widely available.
Cognitive behavioral therapy may also improve sexual functioning in breast cancer survivors [95-96].
A randomized controlled trial studied an internet-based cognitive therapy program . Women who got therapy reported better overall sexual functioning including improved pleasure, desire, arousal and vaginal lubrication compared to women who did not . They also reported reduced discomfort during intercourse .
Learn more about sex, sexuality and intimacy.
Although studies are limited at this time, the following tips may help relieve hot flashes .
Tips for relieving hot flashes
Adapted from the North American Menopause Society .
There is no medical or scientific definition for the term “bio-identical hormones.” So, you may hear this term used in different ways.
Some people use it to describe hormone drugs that have the same chemical and molecular structure as hormones found in the body. (Not all products that claim to be bio-identical meet this definition.)
“Bio-identical" may also refer to hormone therapies that are custom compounded (when a pharmacist makes a mixture of hormones according to a physician’s instructions on a prescription) [98-99].
It's important to remember :
*Please note, the information provided within Komen Perspectives articles is only current as of the date of posting. Therefore, some information may be out of date at this time.
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