'Crash menopause' can occur for some breast cancer survivors. With better support, it doesn’t have to be so overwhelming. Photo / Getty Images
After surviving breast cancer, the menopause should have been straightforward. The reality was anything but.
When I discovered a lump on my right breast, aged 40 in 2021, I was in the best health of my life. With a happy marriage, two great kids, a fun job in journalism and, having taken up running during the pandemic, I was fit as a fiddle. So when the doctor mentioned the C-word, I actually laughed. The very idea that I might have cancer was utterly ridiculous.
But cancer it was: grade three, stage three, triple-negative breast cancer, to be precise.
Treatment involved 16 cycles of intravenous chemotherapy, followed by a mastectomy, 15 rounds of radiotherapy and, finally, a further eight months of adjuvant chemo. In total, my treatment lasted around 18 months.
It was awful. My hair came away in clumps, my skin was red and sore, and my fingernails turned yellow and lifted away from the nail beds, threatening to fall off. I was in a constant battle against tiredness and, after abandoning running, struggled to keep up with my kids on the walk to school. Meanwhile, my periods had stopped. I vaguely remembered one of the items on the long list of potential chemo side effects, on the pages-long consent form that I’d signed, saying my “periods might stop”. But what does that mean?
I asked my oncologist: am I in early menopause? And is it permanent?
“It depends,” was her frustrating answer. “If you’re under 40, we generally expect your periods to come back but, if you’re over 40, we don’t.”
Since I was exactly 40, it could go either way. I resigned myself to waiting it out. My focus was on getting to the end of treatment. After chemo, I told myself: the worst will be over. However, it was when treatment ended that I sank into the darkest period of all.
I couldn’t seem to shift the crippling fatigue that I’d felt during chemo and radiotherapy, nor the weight that I’d gained on the steroids. I couldn’t sleep properly or think straight, and my libido was non-existent. I’d been on an emotional roller-coaster of mood swings for so long that I no longer remembered what “normal” felt like. These were all things that I’d thought would improve after treatment ended, so the fact that they were continuing made me feel absolutely hopeless.
This was happening just as friends and family expected me to be “back to normal”. They wanted me to be happy and bursting with energy again. But during sleepless 4am anxiety spirals, I’d be asking myself: what was the point of surviving cancer for this to be my life?
It was only when I stumbled across the Menopause and Cancer Podcast hosted by Dani Binnington that I heard women describing exactly how I felt. It was like a lightbulb switching on: I wasn’t failing to overcome the side effects of my treatment, I was dealing with the symptoms of early menopause.
I know now that “crash menopause” is when treatment skips the natural decline of perimenopause. Instead, it happens overnight with symptoms hitting like a ton of bricks. And it happens with no warning, so you’re completely unprepared. Nobody had warned me what to expect, or how it might feel.
Early menopause due to cancer treatment can happen in several ways.
Gynaecological cancers might require the removal of the womb or ovaries. This is known as surgical menopause.
With breast cancer, around 80 per cent of tumours are oestrogen-driven, so treatment often involves hormone therapy like Tamoxifen, which works by suppressing oestrogen, causing menopausal symptoms.
My early menopause was caused by chemo extinguishing the ovaries as a side project, while attacking the cancer. For some, periods eventually come back. For me, they didn’t.
If you’ve had oestrogen-driven breast cancer, then hormone replacement therapy (HRT) is clearly not an option, since it creates the opposite effect of the oestrogen-blocking drugs. However, since that was not the case for me, I asked my oncologist if I could have HRT. “No,” she said firmly, “because the cells can mutate so, if it comes back, it might be oestrogen-driven, even if it wasn’t before.”
With HRT off the table, I was left to my own devices. I’m lucky to have a supportive husband, with whom I felt comfortable talking about my symptoms. And I’m lucky to be a naturally persistent person, determined to find ways to live fully, with restored sleep, energy, motivation, libido and mood.
Because, once I started investigating, I learnt that there is actually a lot that can be done to ease symptoms. Much of which, bafflingly, isn’t shared with patients unless they specifically ask.
I learnt that vaginal dryness is easily fixed with vaginal oestrogen, which is administered by cream or pessary, and safe for all women, even after oestrogen-driven breast cancer, because it’s localised.
I learnt that antidepressants are very helpful for some women struggling with the emotional symptoms of menopause, who aren’t able to have HRT (although that route wasn’t right for me).
I learnt that sleep hygiene is not just a buzz phrase invented for magazine features flogging ashwagandha supplements. Actually having a wind-down routine, including not looking at devices right before bed, makes a difference.
But most of all I learnt that your lifestyle has a huge impact on symptoms: not only the most urgent ones, such as mood swings, sleep disturbances, low libido and brain fog, but also the long-term ones such as brain, bone and heart health.
I cut down on alcohol, almost completely, and started doing regular exercise, alternating between calming yoga and strengthening barre. I invested in a weekly organic veg box to ensure I was getting a variety of fibre and nutrients. I prioritised sleep and improved boundaries, at work and in my social life, spending my time and energy more wisely.
I hated the idea that my new life would make me boring, so I launched a weekly newsletter on Substack, all about how to still have fun, while living well.
Eventually, after an overhaul that had me feeling human again, I saw a different doctor who dropped a bombshell by casually asking: “I assume you’re on HRT?”
Well no, I told him, obviously not – I’ve had breast cancer.
He explained that HRT is suitable for some women after breast cancer, if they meet three criteria:
Since I ticked all three boxes, it was decided that the benefits of HRT (for my long-term brain, bone and heart health) outweighed the risks. But I’m on a low dose, and only until I’m 51; the average age at which most people hit natural menopause. So essentially I’m only replacing the oestrogen that my body would have enjoyed, had I not been through chemo. When I come off HRT, I expect I’ll experience some of these symptoms again, but now I feel ready to face them.
Because having a crash menopause on top of a cancer diagnosis is hard but, with more support and information for patients, it really doesn’t have to be so traumatic.
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