Menopause after Breast Cancer

Breast cancer predominantly affects women over the age of 50, with the average age of diagnosis being in the late 60s. However, 1 in 5 women diagnosed with breast cancer are younger than 50 and premenopausal.  

The incidence of breast cancer has been on the rise, with approximately 1 in 7 women facing the risk of developing the disease at some point in their lives. In the UK, there are already over 600,000 individuals living beyond breast cancer, and this number is projected to double by 2030.

Fortunately, the majority of breast cancer cases are detected in the early stages, increasing the chances of successful treatment.

Over the past three decades, the risk of dying from breast cancer has significantly decreased, with a continued decline expected in the future. Recent survival data indicates that more than 9 out of 10 women diagnosed with breast cancer are predicted to survive for at least 5 years, and 8 out of 10 women are expected to survive for 10 years or more.

Causes & Types of Breast Cancer

Genetics play a minor role in breast cancer cases, accounting for less than 10% of them. Lifestyle factors such as obesity, alcohol consumption, smoking, and a sedentary lifestyle are the more significant risk factors, although some cases are simply due to chance.

Breast cancer can be categorised into invasive and non-invasive types.

  • Invasive breast cancer has the potential to spread to other parts of the body;
  • Non-invasive types include ductal carcinoma in situ (DCIS), lobular carcinoma in situ (LCIS), and non-invasive Paget’s disease, which may indicate a higher risk of future breast cancer development.

The specific classification of breast cancer is based on factors like tumour size, grade (cell differences compared to normal cells), and lymph node involvement, with tailored treatment approaches for each individual.

Approximately 75% of breast cancers are oestrogen receptor-positive (ER+), leading to various strategies that aim to block oestrogen’s effects, such as medication (Aromatase Inhibitors or Tamoxifen) and surgical removal of the ovaries.

Having an ER-positive tumour doesn’t imply that oestrogen caused the cancer; instead, it means that further exposure to oestrogen could promote the growth of an existing tumour, hence the need for strategies to block oestrogen’s effects.

Breast Cancer Treatments

Common breast cancer treatments encompass surgery, chemotherapy, radiotherapy, and targeted therapies based on the tumour’s hormone receptor status (oestrogen receptor-positive or negative) and the presence of the HER2 protein.

Surgery remains a crucial component of breast cancer treatment, but additional therapies, either neoadjuvant (before surgery) or adjuvant (after surgery), may be offered to reduce the risk of recurrence or spread.

Decisions about breast cancer treatment should involve discussions about potential side effects and risks, allowing patients to make informed choices that align with their preferences and values.

Cancer treatments, such as chemotherapy and oestrogen-blocking medications, can induce menopause at an earlier age, affecting both symptoms and long-term health.

Women with a history of breast cancer may experience more severe menopause symptoms but might not immediately attribute them to menopause due to their focus on cancer treatment.

Aromatase Inhibitors, which drastically reduce oestrogen levels, can lead to joint pain, vaginal dryness, and urinary symptoms, common menopause-related issues.

Predict Breast Tool

Patients may use the Predict Breast tool, an algorithm designed to aid decisions about breast cancer treatments. It provides survival predictions for 5 or 10 years, factoring in different treatment options.

Breast Cancer & Hormone Replacement Therapy

Seeking treatment for menopause symptoms after breast cancer can be challenging, as Hormone Replacement Therapy (HRT), a common option for managing menopause symptoms, is often contraindicated due to concerns about cancer recurrence.

Unfortunately, women with a history of breast cancer may feel unsupported when discussing menopause-related issues, as there is often a lack of specialised support within the breast cancer care team, limited GP training in menopause management, and limited accessibility to NHS menopause clinics.  

Navigating through conflicting advice can be challenging. 

If you have concerns about the accuracy of information, our expert, Dr. Colinette Margerison, a British Menopause Society Accredited specialist, can provide evidence based guidance on your individual experience and medical history.