In Case You Missed It: Komen EmpowerED: Menopause + Breast Cancer
This virtual Komen EmpowerED: Education After Diagnosis event was designed for women diagnosed with breast cancer who are also navigating menopause.
In the video above, hear from leading experts from the University of Illinois Chicago, including Dr. Makeba Williams, Dr. Pauline Maki and Dr. V.K. Gadi, who will explain which breast cancer therapies can trigger menopause, how and why this happens, and how hormone replacement therapy (HRT) may help. They also speak on recent changes to FDA black box warnings for HRT and what they mean for breast cancer patients. For women who cannot use HRT, alternative and complementary approaches to managing menopausal symptoms were discussed.
What is Menopause?
While all women will eventually go through menopause as they age, many people are surprised to find their breast cancer treatments can rapidly trigger menopause symptoms. Many people may feel blindsided as they navigate both breast cancer treatment as well as menopause symptoms.
Menopause is the ending of the normal menstrual cycle in women and typically occurs naturally in the late 40s or early 50s. You’re considered in menopause after you have not had a period for 12 months. However, some breast cancer treatments can abruptly trigger early menopause. Because the onset of menopause is sudden, these symptoms may be worse than with natural menopause. One study showed that between 65-100% of women treated for breast cancer experience at least one treatment-induced menopause symptom and 73% of women received less than 10 minutes of discussion with their doctors on menopause care.1
For those in treatment, symptom relief options may be limited. Menopausal hormone therapy (MHT), also known as hormone replacement therapy (HRT), is often used to treat symptoms of menopause; however, some MHTs can increase the risk of breast cancer or breast cancer recurrence.
If you are going through early menopause, you are not alone and you don’t have to suffer in silence. Talk with your health care provider about your symptoms and ask what options are right for you to get relief.
Menopause Causes and Symptoms
Menopause occurs when there are low levels of estrogen and progesterone hormones.
- Menopause happens naturally. As women age, the ovaries make less estrogen and progesterone (hormones) over time, which leads to menopause.
- Menopause can be caused by the surgical removal of ovaries (called oophorectomy). Women with specific inherited gene mutations (such as a BRCA1 or BRCA2) have an increased risk of ovarian cancer in addition to having an increased risk of breast cancer. To reduce the risk of a cancer diagnosis, individuals with these mutations may decide to have a salpingo-oophorectomy (surgical removal of fallopian tubes and ovaries). For younger women, this surgery can trigger early menopause.
- Menopause can also be triggered early by some breast cancer treatments. Hormone receptor-positive (HR+) breast cancer is driven by hormones. Specifically, hormones (e.g., estrogen) attach to the cancer cell receptors (i.e., estrogen receptor, ER), which cause cancer growth. Aromatase inhibitors are a type of hormone therapy (also called endocrine therapy) used to lower estrogen levels in the body. Ovarian suppression, using a drug or oophorectomy, also lowers the body’s estrogen. Lowering estrogen levels using either hormone therapies or ovarian suppression slows/prevents growth of HR+ breast cancers. Chemotherapy, another standard treatment, can damage the ovaries which lowers the body’s estrogen production. https://www.komen.org/breast-cancer/treatment/type/chemotherapy/side-effects/long-term/While all of these are effective breast cancer treatments, they can also lead to early menopause.
Laurel, an early-stage breast cancer survivor, describes her early menopause experience caused by breast cancer treatment. She also discussed some ways she addressed it.
Unlike natural menopause where the symptoms appear gradually over time, early menopause symptoms caused by breast cancer treatments can appear suddenly, all at once. These symptoms can impact everyday life and may include:
- Hot flashes
- Night sweats (sleep disruptions)
- Vaginal dryness
- Osteopenia or osteoporosis (bone density loss)
- Muscle or joints aches
- Mood changes
Sonja, an OB/GYN, provides strategies on how to deal with menopause symptoms after breast cancer.
Dr. Makeba Williams, incoming president of The Menopause Society, and breast cancer survivor Claudia McConnel joined Komen’s Real Pink Podcast to discuss treatment-induced menopause, symptom management, mental health and the importance of open conversations to reduce stigma and encourage support. Click here to listen to their conversation.
Menopausal Hormone Therapy (MHT) and Breast Cancer Risk
MHT is approved by the U.S. Food and Drug Administration (FDA) to help alleviate menopause symptoms. It’s recommended to use MHT at the lowest dose for the shortest amount of time needed. However, there are some risks associated with taking these therapies, especially for those who’ve had breast cancer.
- Oral MHTs
Some MHTs can be taken as pills (also known as oral MHTs). The pills are absorbed into your bloodstream and the medicine then circulates throughout your entire body. These therapies are often referred to as systemic MHT.
MHT pills can contain estrogen alone OR estrogen + progestin, which is a synthetic version of progesterone. While both can alleviate menopausal symptoms, specifically hot flashes and vaginal dryness, and estrogen + progestin appears to improve bone health, oral MHTs are not normally given to women who have had breast cancer.
Some studies suggest that MHT pills with estrogen alone increase the risk of breast cancer. They are also known to increase the risk of uterine cancer for women that have not had a hysterectomy or surgical removal of the uterus.
Every year a woman takes the estrogen + progestin pills, her risk of breast cancer goes up slightly. This includes an increase in the risk of local or metastatic recurrence following a breast cancer diagnosis. Furthermore, the risk of blood clots and stroke is increased with estrogen + progestin pills. For women that have taken estrogen + progestin pills for more than 5 years, the risks often outweigh any benefit they provide. Newer data does show, however, that women who are younger than age 60 when they initiate MHT appear to have more benefits and fewer risks using MHT.
While low-dose oral MHTs may be associated with lower risks, it’s important that women speak with their doctor(s) about the benefits and risks of taking these therapies, especially if they are needed for an extended period.
A potential alternative to oral MHTs includes hormone patches that contain either estrogen alone or estrogen + progestin. It is currently unknown if these patches increase the risk of breast cancer, although it is being studied.
- Vaginal MHTs
Vaginal estrogen MHTs include vaginal suppositories, vaginal rings and vaginal creams. These therapies help alleviate the vaginal dryness and irritation caused by menopause. Studies show that these therapies haven’t shown they increase the risk of breast cancer. As a result, the U.S. FDA recently removed the black box warning which had previously been placed on these therapies to warn patients of the potential increased risk of breast cancer. Women, especially those that have been diagnosed with ER+ breast cancer, are still encouraged to speak with their doctors about the benefits and risks of vaginal estrogen therapies before taking them, especially if you’re taking an aromatase inhibitor.
Non-MHT Ways to Treat Menopause Symptoms
Additional options for the treatment of menopause-induced vaginal symptoms include vaginal therapies that don’t include hormones, lidocaine or other oral medications that have hormone effects.
Outside of vaginal symptoms, there are ways to manage other menopause symptoms that don’t involve the use of hormones. These may include easy tips for managing hot flashes and night sweats, other medications that don’t contain hormones (i.e., antidepressants, etc.), acupuncture and cognitive behavioral therapy. Some people may want to use diet supplements or plant-based remedies, but there’s little evidence to support their use and should be discussed with a doctor before using.
The drugs elinzanetant and fezolinetant are FDA-approved for the treatment of hot flashes and night sweats in women. Study findings show each of these drugs may reduce hot flashes and night sweats in women, but only elinzanetant has been studied in women with breast cancer. Elinzanetant may reduce hot flashes and night sweats in women taking tamoxifen or an aromatase inhibitor for breast cancer treatment or breast cancer risk reduction. Fezolinetant hasn’t been studied in women who’ve had breast cancer or in women taking hormone therapy for risk reduction.
Other Considerations
Another significant dilemma of early menopause is fertility. Younger women who undergo breast cancer treatments that trigger menopause may be unable to get pregnant. Women in childbearing age who are diagnosed with breast cancer should discuss any fertility concerns with their doctors before treatment begins so they can know their options and come up with a plan to have children that they are comfortable with.
Melody Johnson, a nurse practitioner who specializes in treatment-induced menopause, joined Komen’s Real Pink Podcast to take a closer look at the fertility considerations. Click here to listen to her conversation.
Find Support
Women who have been diagnosed with breast cancer should know they are not alone—support and trusted information are available. Susan G. Komen offers a wide range of free resources to help individuals navigate menopause, treatment side effects and life after diagnosis.
Through Komen, patients and caregivers can access:
- Breast Care Helpline (1-877 GO KOMEN) offering support from trained specialists
- Educational resources on menopause, hormone therapy and managing side effects
- Patient navigation services to help guide treatment decisions and connect to local care
- Financial assistance programs for eligible individuals undergoing treatment
- A supportive online community where people can share experiences and advice
If you’re experiencing menopausal symptoms after breast cancer treatment, talking with your health care team is an important first step. But additional support can make a meaningful difference in your quality of life. Komen’s resources are designed to make sure you have the information, support and confidence you need every step of the way.
For additional information on menopause and breast cancer, the Komen Patient Care Center can help. Please contact the Komen Breast Care Helpline at 1-877 GO KOMEN (1-877-465- 6636) or email helpline@komen.org. Se habla espanol.
Take the Menopause Quiz and Test Your Knowledge!
You’ve just learned about early menopause due to breast cancer treatments, menopause hormone therapies, non-hormonal symptom relief options and important things to consider like breast cancer and fertility. Take this quiz and see if your knowledge is hot-flash worthy!
That’s Hot: Menopause Quiz
You’ve just learned about early menopause due to breast cancer treatments, menopause hormone therapies, non-hormonal symptom relief options and important things to consider like breast cancer and fertility. Take this quiz and see if your knowledge is hot-flash worthy!
Additional Resources
- The Menopause Society – A leading medical organization providing evidence-based guidance, research and patient education on menopause, including symptom management and hormone therapy
- Menopausia – A Spanish-language resource offering accessible, culturally relevant information about menopause, symptoms and treatment options for Hispanic/Latina communities
- DHHS Fact Sheet: FDA Black Box Warning Removal – An informational update explaining changes to hormone therapy safety warnings, reflecting evolving evidence on risks and benefits for menopausal care