Future Dreams Guide To Breast Cancer Menopause Part 1

Why a breast cancer related menopause is worse and why HRT isn’t recommended

HRT isn’t an option in the vast majority of cases if you’ve got breast cancer or taking drugs to try and prevent it recurring. Dr Liz O’Riordan, health educator and former breast cancer surgeon, author of The Cancer RoadMap who has had breast cancer twice, explains why the menopause is so much harder when you have had breast cancer, what triggers it, the symptoms and why HRT is off limits for most. 

The menopause – when your periods stop and your hormones crash –  can turn your life upside down at the best of times, but having to cope with it on top of breast cancer can be even harder to deal with.  

You’ve been through so much – dealing with hot flushes, night sweats, joint pain, depression, dry vagina, lack of libido and mood swings on top of surgery, chemotherapy and radiotherapy and potential loss of your fertility….. can just feel like a bridge too far. 

Why menopause symptoms can be worse in women with breast cancer

‘The menopause during or after breast cancer is different – it happens very fast as it is chemically or surgically induced and the symptoms can be more severe and intense, explains Dr Liz O’Riordan. 

‘Your hormone levels drop to almost zero within weeks, so you’ll have far less oestrogen than a woman going through a natural menopause. It’s so sudden and unexpected and a really hard whack to the system. 

‘The symptoms can be more intense. I had no idea it was so hard for my patients when I was working as a breast cancer surgeon.’ 

Why you can’t have HRT

Dr Riordan says the majority of breast cancers are hormone sensitive and feed on the female sex hormone oestrogen. 80% of all breast cancers are hormone positive. HRT is not recommended for them by most guidelines, as adding more oestrogen increases the risk of breast cancer cells growing or recurring. 

‘We know that hormone sensitive breast cancers can come back 10 to 20 years later and so we give women drugs to lower their oestrogen levels or stop them producing it completely to reduce the risk of that happening,’ says Dr O’Riordan. 

‘The trouble is social media is full of menopause and how HRT is God’s gift, saying how if you don’t take it you’ll get heart disease and dementia and that’s not true – but  no one is  talking about what to do if you can’t take it because you’ve had breast cancer and there are non-hormonal treatments and lifestyle changes that can being relief for some symptoms.’ 

Younger pre-menopausal women, particularly those in their 20s and 30s, may find menopause particularly challenging, she says. ‘It’s so hard for them when they’re single and dating, as they are experiencing it all before their time, and will have worries about whether they can preserve their fertility. 

‘Women in their 40s may also have to face losing their fertility, as although there are things we can do during chemotherapy to preserve the ovaries by switching them off before the drugs start, the closer you are to menopause, the less likely they are to work.’ 

‘It’s also a shock for women who were on HRT as they were on pre-menopausal hormone levels prior to diagnosis and are told to stop taking it immediately. 

Dr O’ Riordan says some women will have symptoms so severe they are prepared to accept the risk of their breast cancer coming back by taking HRT. ‘That’s a personal choice but they must be made fully aware of the risks to make an informed choice. I think it’s the last resort though. 

‘There are other things doctors may offer such as a treatment break or trying another brand of drug. Talk it over with your cancer team and explore all the options. Coping with menopauses symptoms is hard – but not as hard as your cancer coming back.’ 

Can I have HRT I have triple negative cancer? 

 Triple negative cancer is not hormone sensitive so does that mean that women with this type of cancer can have HRT?  

‘We do know that some triple negative cancers can come home back and switch receptors and become oestrogen receptor (ER) positive, so there is a very small risk that HRT might feed that if it happens in the future, but’s very low,’ says Dr O’Riordan.

Please have a full discussion with your medical teams about HRT.

What are the causes of menopause symptoms during breast cancer treatments and after?

Your chemically induced menopause could be caused by: 

• Chemotherapy drugs: Some chemotherapy drugs cause your periods to stop, sometimes this is temporary, but it can also be permanent.  ‘Some chemo drugs attack the ovaries and switch them off, ‘explains Dr O’Riordan. 

• Ovarian suppression:  This can be done with surgery, drugs or radiotherapy and the purpose is to stop your ovaries producing oestrogen. 

• Hormone therapy: Hormone therapies are prescribed after breast cancer to stop or slow down the growth of hormone receptor positive breast cancer by blocking the effects of oestrogen to lower the risk of recurrence.  

These drugs include tamoxifen (a selective oestrogen receptor modulator (SERM), which blocks oestrogen receptors and stops the oestrogen from telling cancer cells to keep growing.  

Other hormone treatments include aromatase inhibitors such as Letrozole and Anastrozole, which also reduce oestrogen levels. 

Luteinizing Hormone Releasing Hormone (LHRH) agonists, injections which block a hormone made in the pituitary gland that stimulates your ovaries to make and release oestrogen. These include goserelin (Zoladex) and leuprorelin (Prostap ).

Common symptoms of menopause – what to expect? 

There are hormone receptors all over the body including your brain, gut and joints, so reduced/ fluctuating  hormone levels can result in a whole range of symptoms from the  more commonly known hot flushes , night sweats and vaginal dryness, to sleep problems, brain fog, anxiety, depression, heart palpitations, joint pain, lack of sex drive, weight gain around the middle, changes to your skin and hair and a crawling sensation under the skin.

‘Some of the symptoms such as joint pain you might not necessarily connect with menopause, but once you know that oestrogen hormone receptors are located in every part of the body it starts to make sense,’ says Dr O’Riordan. 

‘The important thing to know is that there a whole host of lifestyle changes and non-hormonal treatments you can try to ease your symptoms , just because HRT is not on the table for most people with breast cancer or who have had it – doesn’t mean you have to have to just soldier on’.

Guide To Breast Cancer Menopause Part 2

Dr Liz O’Riordan, health educator, author of The Cancer Roadmap and former breast cancer surgeon who has had breast cancer twice, gives the lowdown on self-help lifestyle changes, and medication to help make menopause more bearable.

More on Menopause from cancer treatment – advice and support

Some breast cancer treatments can lead to early menopause, or menopausal symptoms. This expert advice and support is here to help answer your questions.

Breast cancer support: book classes, therapies and workshops

If you, or a loved one, have been diagnosed with breast cancer, Future Dreams can offer support In-person or online, wherever you are in the UK. We have a wide variety of group and individual support at any stage of a breast cancer diagnosis.

About the author

Dr Liz O’Riordan – a distinguished speaker, author, and former consultant breast surgeon who has transformed personal adversity into a powerful platform for education and inspiration. Diagnosed with breast cancer three times, Liz offers a unique perspective that bridges the gap between medical expertise and patient experience. Throughout her career, Liz has been recognised for her contributions to breast cancer awareness and patient care. She was awarded the Humanitarian Award from Future Dreams Charity in 2024 for her advocacy work.

Further advice

Future Dreams hold a range of support groups, classes, workshops and events to help you and your carers during your breast cancer diagnosis. These are held both online and in person at the London-based Future Dreams House. To see what’s on offer and to book your place, see here.

To return to the homepage of our Information Hub, click here where you can access more helpful information, practical advice, personal stories and more.

Reviewed October 2025

The information and content provided in all guest articles is intended for information and educational purposes only and is not intended to substitute for professional medical advice. It is important that all personalised care decisions should be made by your medical team. Please contact your medical team for advice on anything covered in this article and/or in relation to your personal situation. Please note that unless otherwise stated, Future Dreams has no affiliation to the guest author of this article and he/she/they have not been paid to write this article. There may be alternative options/products/information available which we encourage you to research when making decisions about treatment and support. The content of this article was created by Dr Hannah Short and we accept no responsibility for the accuracy or otherwise of the contents of this article.