WHAT IF I HAVE BREAST CANCER?
What are my options if I have or have had breast cancer?
If you have breast cancer now or are a breast cancer survivor, you may have more intense menopause symptoms than your friends without breast cancer.
Estrogen-containing medicines that might help with your menopause symptoms are not usually recommended for women who have had breast cancer. The MyMenoPlan Tool can help you avoid risky treatments. We also have more detailed information below. Feel free to share it with your doctors.
About two-thirds of breast cancer survivors have hot flashes. Many things can cause these hot flashes. Some cancer treatments quickly stop the ovaries from making hormones. This can cause a sudden and intense menopause. And some of the drugs used long-term after breast cancer can cause hot flashes. Hot flashes tend to be worse during chemotherapy or when starting tamoxifen, aromatize inhibitors, or drugs that shut down your ovaries temporarily (e.g. Lupron). Hot flashes then stabilize or decrease slightly over time and depending on your cancer treatments and your age, the ovaries may resume normal function.
Physical changes, emotional changes, and intimacy
Breast cancer treatments can cause physical and emotional changes. Those changes can affect your body image, feelings about intimacy, and your sex life. Some women worry about how their body looks and are concerned about how their partner sees them. Other women stop desiring sex. During sex, some women feel their vagina is dry or sore, or they find it hard to have an orgasm. Even women who don’t have sex can feel discomfort from vaginal dryness and atrophy. Vaginal atrophy is a thinning and drying of the vaginal wall.
Treatment options for breast cancer patients or survivors
The sections below point you to safe ways to deal with hot flashes and vaginal symptoms. Since hormonal treatments increase the risk of breast cancer recurrence, they are usually avoided (except for low doses of vaginal estrogen). Hormonal treatments that usually are not recommended are estrogen or progesterone pills, patches or gels.
Improving hot flashes
You can try the following treatments on your own or with a specialist. They do not require prescriptions. Some have been shown to work. Others may help and won’t hurt you. We also let you know which treatments don’t seem to work. As always, every woman is unique, so treatments that help some women may not work for you.
- Cooling techniques: The easiest things to try aren’t really treatments. They are ways to make yourself more comfortable during a hot flash. Our section on cooling techniques has lots of suggestions. You can also ask your friends and family what their favorite cooling techniques were. Try some yourself and see what helps.
- Hypnosis: Hypnosis decreases how often women with breast cancer get hot flashes and how bad they feel.
- Acupuncture: It may be worth trying acupuncture. Some studies show that the number of hot flashes decreases with acupuncture treatments one to two times per week for up to 12 weeks. Other studies show no effect of acupuncture. However, the studies are mostly of poor quality, so it is not clear what the effect really is. The main side effects of acupuncture are mild pain and bruising from needles.
- Yoga: Yoga may decrease the number of hot flashes in women after breast cancer.
- Mindfulness based practices: Mindfulness based practices generally do not decrease hot flashes for women with breast cancer.
Several hormone-free medicines decrease hot flashes and are safe in breast cancer survivors. The treatments help whether or not you are taking tamoxifen or aromatase inhibitors. They can be prescribed by your healthcare provider.
- There is a group of antidepressant drugs that can help with hot flashes. Venlafaxine (Effexor, 75 mg per day), citalopram (Celexa, 10, 20 or 30 mg per day), paroxetine (Paxil, Brisdelle, 10 mg per day), duloxetine (Irenka, Cymbalta, 60 mg per day), escitalopram (Lexapro 10, 20 or 30 mg), and desvenlafaxine (Pristiq, 25, 50, 100 mg) reduced both the frequency and severity of hot flashes by 50% after 4-6 weeks of therapy. Common side effects are nausea, dizziness, and dry mouth. A note of caution is important for two of these drugs: paroxetine and duloxetine. It has not been proved, but they might affect how well tamoxifen works.
- Clonidine (0.1 mg daily) is an older blood pressure medication. A clonidine patch reduced hot flash frequency and severity by 50% after 4-6 weeks of use. The most common side effects of clonidine are dry mouth and constipation.
- Gabapentin (900 mg per day) or pregabalin (15 mg per day) reduced hot flash frequency and severity by 50% after 4-6 weeks.
The following treatments have not improved hot flashes in breast cancer survivors. They have been studied using the “gold standard” of research methods – in randomized controlled trials. The treatments that do not affect hot flashes are: black cohosh, aerobic exercise, soy and phytoestrogens, vitamin E, fluoxetine, sertraline and bupropion.
Improving vaginal health / sexual health
You may experience problems such as vaginal dryness, pain during sex, or low sex drive. The solutions for breast cancer patients and survivors are the same as for other women. Before trying vaginal estrogen consider trying vaginal lubricants or moisturizers.
You can read more about each of these symptoms:
and potential treatments and coping strategies:
- Vaginal estrogen
- Vaginal lubricants and moisturizers
- Vaginal laser therapy
- Vaginal dilators
- Vaginal physical therapy
If your cancer diagnosis or treatments are affecting your sex life you also might consider seeing a therapist yourself or with your partner.
No consistent improvements in sexual health were seen with physical activity, transdermal testosterone, vaginal testosterone, or anti-depressants.
No published studies in breast cancer survivors were found on: DHEA (dehydroepiandrosterone), vaginal dilators, vaginal physical therapy, pelvic floor exercises, ospemifene or flibanserin.
Barton DL, LaVasseur BI, Sloan JA, et al. Phase III, placebo-controlled trial of three doses of citalopram for the treatment of hot flashes: NCCTG trial N05C9. J Clin Oncol. 2010;28(20):3278‐3283. doi:10.1200/JCO.2009.26.6379
Barton DL, Loprinzi CL, Quella SK, et al. Prospective evaluation of vitamin E for hot flashes in breast cancer survivors. J Clin Oncol. 1998;16(2):495‐500. doi:10.1200/JCO.19220.127.116.115
Boekhout AH, Vincent AD, Dalesio OB, et al. Management of hot flashes in patients who have breast cancer with venlafaxine and clonidine: a randomized, double-blind, placebo-controlled trial. J Clin Oncol. 2011;29(29):3862‐3868. doi:10.1200/JCO.2010.33.1298
Bokmand S, Flyger H. Acupuncture relieves menopausal discomfort in breast cancer patients: a prospective, double blinded, randomized study. Breast. 2013;22(3):320‐323. doi:10.1016/j.breast.2012.07.015
Bordeleau L, Pritchard KI, Loprinzi CL, et al. Multicenter, randomized, cross-over clinical trial of venlafaxine versus gabapentin for the management of hot flashes in breast cancer survivors. J Clin Oncol. 2010;28(35):5147‐5152. doi:10.1200/JCO.2010.29.9230
Carson JW, Carson KM, Porter LS, Keefe FJ, Seewaldt VL. Yoga of Awareness program for menopausal symptoms in breast cancer survivors: results from a randomized trial. Support Care Cancer. 2009;17(10):1301‐1309. doi:10.1007/s00520-009-0587-5
Cramer H, Rabsilber S, Lauche R, Kümmel S, Dobos G. Yoga and meditation for menopausal symptoms in breast cancer survivors-A randomized controlled trial. Cancer. 2015;121(13):2175‐2184. doi:10.1002/cncr.29330
Desmarais JE, Looper KJ. Interactions between tamoxifen and antidepressants via cytochrome P450 2D6. J Clin Psychiatry. 2009;70(12):1688‐1697. doi:10.4088/JCP.08r04856blu
Elkins G, Marcus J, Stearns V, et al. Randomized trial of a hypnosis intervention for treatment of hot flashes among breast cancer survivors. J Clin Oncol. 2008;26(31):5022‐5026. doi:10.1200/JCO.2008.16.6389
Goetsch MF, Lim JY, Caughey AB. A Practical Solution for Dyspareunia in Breast Cancer Survivors: A Randomized Controlled Trial. J Clin Oncol. 2015;33(30):3394‐3400. doi:10.1200/JCO.2014.60.7366
Goldberg RM, Loprinzi CL, O’Fallon JR, et al. Transdermal clonidine for ameliorating tamoxifen-induced hot flashes [published correction appears in J Clin Oncol 1996 Aug;14(8):2411]. J Clin Oncol. 1994;12(1):155‐158. doi:10.1200/JCO.1918.104.22.168
Hayes SC, Rye S, Disipio T, et al. Exercise for health: a randomized, controlled trial evaluating the impact of a pragmatic, translational exercise intervention on the quality of life, function and treatment-related side effects following breast cancer. Breast Cancer Res Treat. 2013;137(1):175‐186. doi:10.1007/s10549-012-2331-y
Kimmick GG, Lovato J, McQuellon R, Robinson E, Muss HB. Randomized, double-blind, placebo-controlled, crossover study of sertraline (Zoloft) for the treatment of hot flashes in women with early stage breast cancer taking tamoxifen. Breast J. 2006;12(2):114‐122. doi:10.1111/j.1075-122X.2006.00218.x
Lesi G, Razzini G, Musti MA, et al. Acupuncture As an Integrative Approach for the Treatment of Hot Flashes in Women With Breast Cancer: A Prospective Multicenter Randomized Controlled Trial (AcCliMaT). J Clin Oncol. 2016;34(15):1795‐1802. doi:10.1200/JCO.2015.63.2893
Loibl S, Schwedler K, von Minckwitz G, Strohmeier R, Mehta KM, Kaufmann M. Venlafaxine is superior to clonidine as treatment of hot flashes in breast cancer patients–a double-blind, randomized study. Ann Oncol. 2007;18(4):689‐693. doi:10.1093/annonc/mdl478
Loprinzi CL, Kugler JW, Sloan JA, et al. Venlafaxine in management of hot flashes in survivors of breast cancer: a randomised controlled trial. Lancet. 2000;356(9247):2059‐2063. doi:10.1016/S0140-6736(00)03403-6
Loprinzi CL, Qin R, Balcueva EP, et al. Phase III, randomized, double-blind, placebo-controlled evaluation of pregabalin for alleviating hot flashes, N07C1 [published correction appears in J Clin Oncol. 2010 Apr 1;28(10):1808. Baclueva, Ernie P [corrected to Balcueva, Ernie P]]. J Clin Oncol. 2010;28(4):641‐647. doi:10.1200/JCO.2009.24.5647
Loprinzi CL, Sloan JA, Perez EA, et al. Phase III evaluation of fluoxetine for treatment of hot flashes. J Clin Oncol. 2002;20(6):1578‐1583. doi:10.1200/JCO.2002.20.6.1578
Mao JJ, Bowman MA, Xie SX, Bruner D, DeMichele A, Farrar JT. Electroacupuncture Versus Gabapentin for Hot Flashes Among Breast Cancer Survivors: A Randomized Placebo-Controlled Trial. J Clin Oncol. 2015;33(31):3615‐3620. doi:10.1200/JCO.2015.60.9412
Nuñez GR, Pinczowski H, Zanellato R, et al. Bupropion for control of hot flashes in breast cancer survivors: a prospective, double-blind, randomized, crossover, pilot phase II trial. J Pain Symptom Manage. 2013;45(6):969‐979. doi:10.1016/j.jpainsymman.2012.06.011
Pandya KJ, Morrow GR, Roscoe JA, et al. Gabapentin for hot flashes in 420 women with breast cancer: a randomised double-blind placebo-controlled trial. Lancet. 2005;366(9488):818‐824. doi:10.1016/S0140-6736(05)67215-7
Pockaj BA, Gallagher JG, Loprinzi CL, et al. Phase III double-blind, randomized, placebo-controlled crossover trial of black cohosh in the management of hot flashes: NCCTG Trial N01CC1. J Clin Oncol. 2006;24(18):2836‐2841. doi:10.1200/JCO.2005.05.4296
Pruthi S, Qin R, Terstreip SA, et al. A phase III, randomized, placebo-controlled, double-blind trial of flaxseed for the treatment of hot flashes: North Central Cancer Treatment Group N08C7. Menopause. 2012;19(1):48‐53. doi:10.1097/gme.0b013e318223b021
Seav SM, Dominick SA, Stepanyuk B, et al. Management of sexual dysfunction in breast cancer survivors: a systematic review. Womens Midlife Health. 2015;1:9. Published 2015 Nov 2. doi:10.1186/s40695-015-0009-4
Stearns V, Slack R, Greep N, et al. Paroxetine is an effective treatment for hot flashes: results from a prospective randomized clinical trial [published correction appears in J Clin Oncol. 2005 Nov 20;23(33):8549]. J Clin Oncol. 2005;23(28):6919‐6930. doi:10.1200/JCO.2005.10.081
Walker EM, Rodriguez AI, Kohn B, et al. Acupuncture versus venlafaxine for the management of vasomotor symptoms in patients with hormone receptor-positive breast cancer: a randomized controlled trial. J Clin Oncol. 2010;28(4):634‐640. doi:10.1200/JCO.2009.23.5150
Authors: Dr. Irene Sue, Dr. Katherine Newton, & Dr. Leslie Snyder. Last reviewed February 15, 2021