If you’re experiencing menopause, your periods will stop.

They may first become irregular. Changes in the pattern of menstruation, usually less frequent, but heavy bleeding can also occur. For some women their periods may stop suddenly.

Menopausal symptoms can be particularly distressing for younger women.

Most menopausal symptoms will resolve with time. However, for some women, the stress and emotional burden of menopause can be overwhelming

Remember, it’s ok to ask for help. You may find it helpful to tell those close to you about what is happening and how your symptoms make you feel. Support and understanding from others can help you manage your symptoms.

Emotional responses to menopausal symptoms vary greatly between women.

Younger women may have particular concerns about loss of libido, loss of fertility or a feeling of growing old prematurely. Sleep deprivation associated with night sweats can also result in moodiness and irritability.

Managing mood changes can be more of a challenge for women who are working or caring for young children. Recognising these symptoms and allowing time for self-care (‘time out’) can help.

If you’re experiencing feelings that are overwhelming you or interfering with your daily activities, talk to your treatment team.

Hot flushes are a side effect of many hormonal treatments for breast cancer and are common during menopause.

Hot flushes may come and go and are not always severe. The duration of hot flushes also varies between women. Some women may experience hot flushes for many years.

What helps ?

Although we don’t know how to stop hot flushes, there are some things you can do to help manage the symptoms:

• wear natural fibres like cotton which absorb sweat
• dress in layers, so that it’s easy to take off an item of clothing when you experience a hot flush
• reduce your intake of caffeine, alcohol, hot drinks and spicy foods
• keep a small fan in your work area and drink cold water to cool you down
• keep a note of when you experience hot flushes and what you’re doing when they occur; this may help you identify the ‘triggers’ that cause your flushes and help you find ways to avoid them
• consider yoga, meditation or relaxation techniques
• consider other lifestyle strategies, such as a healthy  diet, regular exercise,  and not smoking. 

Staying cool in bed?

• keep cold water by your bed ready to drink at the first sign of a sweat
• use cotton sheets and cotton nightclothes
• sleep under layers, so you can easily remove extra bed covers
• have a small fan running to keep the air moving while you sleep.

If you think you would find it helpful to share your experiences with other women, you may like to join a support group. Meetings can be face-to-face or held over the telephone or internet.

Menopause can cause a loss of libido, and can decrease your desire for sexual intimacy.

Managing these symptoms may require some effort – and open communication between you and your partner.

Some women say it takes longer to become aroused and experience orgasm during and after menopause. The loss of desire and libido may be directly related to lower levels of the hormones oestrogen, progesterone or testosterone. Vaginal dryness and pain may further increase the problem.

Changes in libido may not only be the result of your menopausal symptoms. Breast cancer and its treatment can influence your overall sense of femininity and sexuality. This can happen to any woman, whether or not she has a partner.

What helps?

There is a range of practical and lifestyle remedies that can help manage some of the effects of early menopause on sexuality and libido, including managing vaginal dryness.

• Be open with your partner; explain what is happening and what might be helpful for you.
• Relaxation techniques may help to reduce your stress levels and help you refocus on your relationship.
• Treat vaginal dryness if it’s causing discomfort. 
• Downplay the importance of sexual intercourse and orgasm, at least for a while. Instead, focus on the pleasure of touching, kissing, and imagery. Women may need foreplay to become properly aroused, so don’t hurry this aspect of your relationship, and let your partner know what helps.
• You and your partner may find it helpful to talk to a health professional – you can do this together or separately. You may want to ask for advice from a trained specialist such as a relationship counsellor or sex therapist.

Menopause can reduce the body’s production of the hormone oestrogen. Oestrogen is important for maintaining the moisture and elasticity (stretch) of the vagina. 

When oestrogen levels are lower, vaginal dryness and loss of vaginal elasticity can make sexual intercourse uncomfortable or painful. Unlike hot flushes, vaginal dryness does not improve with time and may be a long-term problem unless treated.

What to do about vaginal dryness?

The most effective solution for vaginal dryness is to use a product that will add moisture to the vaginal tissue. There are three types of vaginal moisturisers. All are applied directly into the vagina.

Non-hormonal vaginal moisturisers

Non-hormonal vaginal moisturisers provide relief from the uncomfortable symptoms of vaginal dryness. These products come in a semi- liquid form and are usually applied twice a week. They are available from most pharmacies.

Vaginal gels and lubricants

Vaginal pH-balanced gels are used to prevent and treat vaginal dryness. With a pH similar to that of normal vaginal discharge, these gels have been found to improve vaginal dryness and vaginal pH in women after breast cancer.

Vaginal lubricants provide lubrication to enhance the comfort and ease of sexual intercourse. If you use a vaginal lubricant choose a water-based or silicon-based lubricant rather than oil-based lubricants which may increase the risk of getting yeast infections. These products come as ‘semi-gel’ creams and are available from pharmacies.

Applying a gel containing a local anaesthetic to the area around the vulva immediately before sexual intercourse may reduce pain and discomfort associated with penetration.

Vaginal oestrogens

Vaginal oestrogens are creams, rings or tablets containing low doses of the hormone oestrogen that are inserted directly in the vagina. They are designed to help reduce symptoms associated with vaginal dryness and discomfort with sexual activity.

Small amounts of vaginal oestrogen may be absorbed into the body. For women taking aromatase inhibitors this may result in measurable increases in circulating oestrogens. The clinical significance of systemic absorption is uncertain, and for this reason some oncologists advise that some women avoid vaginal oestrogens after breast cancer. It has not been shown that vaginal oestrogens increase the risk of breast cancer recurrence or spread. Vaginal oestrogens should only be prescribed by a medical practitioner who is aware of your history of breast cancer and use of vaginal oestrogens should be discussed with your treatment team.

We don’t yet know whether vaginal oestrogens are safe after breast cancer. It is important to talk to your oncologist or general practitioner about your options.

Other ways of managing vulvovaginal dryness

Avoid substances that can irritate or dry the vaginal region, such as soap, or products containing alcohol or perfume. Products containing petroleum jelly and baby oil can also cause irritation. Use a soap-free product to wash the vaginal area.

Wear cotton underwear and avoid nylon underwear, tight underwear, or tight clothing.

If you’re sexually active, discuss your concerns with your partner. If your partner is aware of how you feel, they are more likely to help you explore alternatives.

Simple strategies, such as changing the position for intercourse, can relieve discomfort. Pain during sex can make you tense, and that tension can cause more pain. Try exploring alternative ways to be intimate so you and your partner can maintain a pleasurable and satisfying sexual relationship.

Many women experience disturbed sleep during menopause.

You may wake up sweating from a hot flush. Other common problems include repeated awakenings, difficulty getting back to sleep and difficulty falling asleep. Disrupted sleep can cause fatigue and tiredness. If this is causing tiredness during the day, or if you’re regularly waking up feeling anxious and worried, consider speaking with your GP or another member of your treatment team. They will be able to talk to you about techniques and treatments to help you sleep.

What can help?

There are a number of things that may help you sleep better.

• Before bed, avoid caffeine-based drinks, alcohol, and other stimulants like cigarettes. Try a non-stimulating herbal tea like chamomile instead.
• Use the bedroom for sleep only – no TV or written work (sex is fine!).
• Establish a regular bedtime and waking routine – it’s OK to take short naps (no longer than an hour) during the day, but try not to rest for long periods.
• Keep the bedroom cool.
• Gently increase physical activity during the day – such as walking or swimming.
• Try controlled breathing – deep slow abdominal breathing.
• Consider a short-term mild sedative – a GP can provide a prescription.

Feeling fatigued or constantly tired is a common symptom of menopause and is a side effect of treatments for breast cancer such as chemotherapy and radiotherapy.

During menopause, disrupted or reduced sleep is the major cause of fatigue and tiredness. Regardless of what is causing your tiredness, exercise may help reduce the symptoms.

What can help?

• Establish a gentle regular exercise program, increasing your level of activity gradually and varying the exercise so you don’t get bored.
• If you haven’t exercised for a while or have other medical conditions, ask your general practitioner about the type and amount of exercise you should undertake.
• Ask a friend to exercise with you to help keep you motivated.
• If you’re experiencing significant fatigue, take on a small activity, followed by a rest period, followed by another activity.
• Avoid long periods resting in bed; it will only increase your fatigue.
• Eat a diet that includes at least 5 serves of vegetables and 2 serves of fruit a day.
• Drink enough water (about 8 glasses a day is recommended) so that you do not feel thirsty. Dehydration can also be the cause of fatigue.

Menopause does not cause you to lose your memory.

However, changes in sleep pattern, tiredness, depression and anxiety can cause you to become forgetful and may impair your mental functioning.

What can help?

• Make lists of things that are important to remember.
• Stay mentally active—try a crossword, Sudoku or quizzes.
• Keep a brief diary of appointments and things to do and check it regularly.
• Regular exercise can help improve your sleep patterns and your mood.
• Explain to your family and friends what is happening to you so they can help and give you support.

Bladder problems – such as incontinence (urine leakage), passing urine more frequently at night and urinary tract infections – can become more common during menopause. 

If you experience a burning pain when passing urine, or if you feel the need to go to the toilet frequently yet pass only small amounts of urine or the urine smells unpleasant, see your general practitioner. You may have a bladder infection that requires treatment with antibiotics.

What can help maintain bladder health?

• Drink sufficient fluids – especially early in the day.
• Go to the toilet promptly when your bladder is full.
• Pass urine directly after intercourse.
• Wipe from front to back after using the toilet.
• Talk to your doctor about topical oestrogen.

What can help avoid incontinence?

• Try pelvic floor exercises to reduce urine leakage and improve bladder control. Exercise brochures are available from most general practitioners and chemists. You may find it helpful to seek advice from a physiotherapist - ask your general practitioner or breast care nurse for a referral.
• Keep your weight within normal limits for your height.
• Avoid stimulants for coughing, like cigarettes
• Avoid food and drinks containing high levels of caffeine, as this can irritate the bladder and can increase incontinence.
• Visit your local continence advisory service. Ask your general practitioner or breast care nurse for more information.

Painful joints can be a problem associated with menopause, and can also be a side effect of drugs used to treat breast cancer, such as aromatase inhibitors. Sometimes joints can feel stiff and sore.

What can help?

• Exercise can help to maintain a range of movement and maintain a healthy weight. You can speak to an exercise physiologist about what exercise would be good for you.
• You may wish to talk to a dietitian and ask about recommended diet or vitamin supplements. 
• Talk to your general practitioner if you have bone or joint pain to check that you don’t have other joint changes, such as arthritis.

Weight gain is common during both cancer treatment and menopause.

Maintaining a healthy weight is an important aspect of a long-term health for cancer survivors. There are many ways to avoid weight gain, and to lose additional weight if you put it on. Talk to your general practitioner, breast care nurse or ask to speak to a dietitian for advice.

Talk to your general practitioner, breast care nurse or ask to speak to a dietitian for advice. 

What can help avoid weight gain?

• Eat a healthy diet, including lots of fresh fruit and vegetables.
• Reduce your intake of foods with saturated fat, added salt and added sugar.
• Drink more water and less sugary liquids like soft drink and fruit juice.
• Participate in regular physical activity, aiming for at least 30 minutes of moderate-intensity activity every day, and limiting sedentary habits (the time you spend sitting or lying down).
• If you choose to drink alcohol, limit your intake.
• You can get detailed advice on your particular needs from a dietitian.
• To find an accredited dietitian near you

Some women find it helpful to take ‘time out’. 

This can mean enjoying a long bath, a massage, weekends away with loved ones, or a long walk in a favourite environment. Taking care of yourself is not being selfish. The relaxation it brings can reduce stress levels and help you to cope.