Surviving cancer has a way of putting everything else into perspective. A hot flash? A stiff shoulder? A terrible night’s sleep? Compared with everything you just went through, those complaints can sometimes feel too small to mention.
But Brittany Katz, MD, a menopause specialist and medical director for the Center for Menopause and Midlife Health, part of the Katz Institute for Women’s Health, wants cancer survivors to discuss them anyway.
“I don't want cancer survivors to think that they should be happy just to be cancer-free,” Dr. Katz says. Of course, getting the all-clear is worth focusing on, but she doesn’t believe survival should be the only goal. “That's a low bar,” she says. “We can still work on non-life-threatening issues, and you're allowed to complain about them, too.”
For many women — particularly those treated for hormone-receptor-positive cancers like breast, ovarian, or uterine cancer — treatment can bring on menopause abruptly. Common menopause symptoms like hot flashes, night sweats, vaginal dryness, brain fog, mood changes, and joint pain can seemingly arrive all at once.
And too many women assume that's simply the price of getting better.
Why cancer survivors stay quiet about menopause symptoms
Before cancer treatment begins, doctors understandably prepare patients for potential side effects. But Dr. Katz says there's a crucial second half of that conversation that can get lost.
“Whenever there's a menopause-related side effect, we often, in treatment, will say, ‘Hey, these are the things to expect,’” she says. “But we also need to follow that up with, ‘There are ways to manage them.’”
In other words, expectation doesn't mean untreatable.
There's another complication: After cancer, a new ache, pain, or change in your body can be scary. Survivors may wonder whether it's a lingering treatment effect, menopause, or a sign that their cancer has returned. So when a doctor reassures them that a symptom is “normal,” they may hear, "You have to live with it." But you don't.
The menopause symptom you might not expect: joint pain
Hot flashes get all the attention, but Dr. Katz says joint pain frequently catches women by surprise. “When estrogen drops dramatically, which it tends to around perimenopause or with dramatic menopause after cancer care, your tissues can get really tight and stiff,” she explains. “Then you're more likely to get injured.”
One common complaint is frozen shoulder, a painful condition that can severely limit how far you can move your arm. Because cancer treatments themselves can also cause joint pain, survivors may not connect those aches with hormonal changes.
Mood changes and vaginal symptoms can also be overlooked. “Many women dismiss these in the grand scheme of things, like, 'Who cares? I don't need to talk about that,’” Dr. Katz says. “But it is important. It's so important.”
Why treatment-induced menopause can feel so intense
Natural menopause is a gradual transition. Treatment-induced menopause can feel more like someone flipped a switch, explains Dr. Katz. Cancer treatments that remove the ovaries or suppress hormones can cause estrogen levels to drop abruptly rather than gradually.
“Studies show that surgical menopause is much more severe,” Dr. Katz says. “Women are more likely to have symptoms and complications of those symptoms.”
She also points to long-term concerns such as osteoporosis, making the conversation about more than simply relieving temporary discomfort. So what can you do if you've already been told hormones aren't an option? More than you might think.
Non-hormonal menopause treatment
When a patient hears, “Hormones aren't right for you,” it can understandably sound like, “There's nothing we can do.” But Dr. Katz says that's no longer the case.
“We have a lot of treatment options now, thankfully, and more hitting the market soon,” she says. Those include newer non-hormonal medications for vasomotor symptoms — the medical term for hot flashes and night sweats. Dr. Katz discussed medications such as fezolinetant and elinzanetant, which target pathways involved in the body's temperature regulation.
“The goal of therapy should be that you don't have hot flashes anymore,” she says. “I can't promise we get to 100 percent with every woman, but that’s the goal.”
Treating menopause without systemic hormone therapy may require several approaches. A medication that helps hot flashes, for example, may not address vaginal dryness or joint pain. “We might have to use multiple therapies,” Dr. Katz says. “But there are plenty of options to treat each and every one.”
For vaginal symptoms, those options can include non-hormonal lubricants and pelvic floor therapy. Dr. Katz also says many survivors may be candidates for vaginal estrogen, depending on their individual circumstances and cancer history — something to discuss with an oncologist and menopause specialist rather than assuming it's automatically off-limits.
Can a cancer survivor ever take hormone therapy?
Sometimes, but there's no universal answer. “It depends on the type of cancer, how far out from treatment they are, and on their treatment modality,” Dr. Katz says.
That’s why personalized care is especially important for cancer survivors navigating menopause. Dr. Katz describes it as a risk-benefit conversation that should involve the patient's oncologist and, ideally, a menopause specialist. The Menopause Society has a list of providers certified by its licensing exam and specialized in menopause care. Dr. Katz is certified by The Menopause Society, as are all clinicians within Northwell’s Center for Menopause and Midlife Health.
What else can help?
Dr. Katz says lifestyle changes can help, too. Even five or 10 minutes of exercise a day may help, and she recommends keeping the bedroom cool for night sweats and eating a Mediterranean-style diet.
Sleep is especially important. Magnesium glycinate and melatonin may help some women, she says, although supplements should always be cleared with a doctor first, particularly during or after cancer treatment.
If your doctor says “This is normal,” push back
One of Dr. Katz's most useful pieces of advice is surprisingly simple: Change the question. Instead of only asking, "Is this normal?" also ask, "Can we do something about it?"
Your doctor may be trying to reassure you that a symptom doesn't mean your cancer has returned. But “normal” and “treatable” aren't opposites, explains Dr. Katz.
And if your doctor isn't comfortable managing menopause after cancer, Dr. Katz says that doesn't necessarily mean they don't care. “I think a lot of providers don't know and are uncomfortable with managing it,” she says.
A certified menopause specialist can be another resource, particularly one who will coordinate with your oncology team.
Maybe treatment ended last year. Maybe it ended decades ago. Either way, Dr. Katz says there's no expiration date on asking for relief.
As Dr. Katz puts it: “This is still your body; don't let cancer take that away from you."
The information provided on this site isn’t intended as medical advice, and shouldn’t replace professional medical treatment. Consult your doctor with any serious health concerns.
