Key points

  1. An early menopause, estrogen deficiency symptoms and arthralgia are common side effects of systemic breast cancer therapies.
  2. Symptoms may persist for the duration of treatment and in some cases continue after treatment completion.
  3. The NICE Menopause Guideline [NG23] recommends referral of women to a healthcare professional with expertise in menopause for counselling about the risk of developing an early menopause and the management of estrogen deficiency symptoms associated with breast cancer treatment.
  4. Lifestyle measures and non-hormonal interventions should be first-line management for estrogen deficiency symptoms but if these are ineffective systemic hormone replacement therapy or low-dose topical estrogen may be considered but only after taking specialist advice.
  5. Lifestyle measures such as weight loss and increased exercise may also improve arthralgias associated with aromatase inhibitors and tamoxifen.
  6. Switches to endocrine breast cancer treatment may alleviate symptoms of estrogen deficiency and arthralgia but these should only be instigated with agreement from the breast specialist team.
Authors: Miss Jo Marsden, Consultant Breast Surgeon, King’s College Hospital, London, Mr Mike Marsh, Consultant Gynae-endocrinologist, King’s College Hospital, London, Dr Anne Rigg, Consultant Medical Oncologist, Guy’s and St Thomas’ Hospital, London, in collaboration with the medical advisory council of the British Menopause Society.

Updated: September 2025

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