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.

Hot Flashes
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.

Fezolinetant  (45 mg daily), a new medication reduced hot flashes by 2.5 per day above background and improves sleep and quality of life.

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:

• Pain with sex
• Vaginal pain or dryness not during sex
• Low sex drive

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.

REFERENCES
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Authors: Dr. Irene Sue, Dr. Katherine Newton, & Dr. Leslie Snyder.  Last reviewed February 15, 2021