If you’ve had breast cancer or another hormone-sensitive cancer, navigating perimenopause comes with different constraints. Some of the most effective treatments—hormones—may be off the table. Providers may be hesitant to try anything at all.
But having a cancer history doesn’t mean you have no options. It means the conversation needs to be more careful. And the recent development of truly non-hormonal treatments has been particularly significant for women in your situation.
What Changes
Systemic hormone therapy is generally contraindicated. If you’ve had estrogen-receptor-positive breast cancer, systemic estrogen—even the low doses used in menopausal hormone therapy—could theoretically stimulate any remaining cancer cells. Most oncologists advise against it.
Some treatments become more important, not less. Cancer treatment itself (chemotherapy, hormonal therapies like tamoxifen or aromatase inhibitors) often induces or worsens menopausal symptoms. You may need relief more than women whose transition is natural.
Individual risk assessment matters. The specific guidance depends on your cancer type, hormone receptor status, time since diagnosis, and current treatment. What’s right for you may differ from what’s right for another survivor.
The New Non-Hormonal Options
For women who can’t take hormones, the NK3 receptor antagonists represent the first genuinely effective non-hormonal treatment for hot flashes.
- FDA approved 2023
- Works directly on the brain mechanism causing hot flashes
- No estrogen, no hormonal effects
- About 60% reduction in hot flash frequency
- Requires liver enzyme monitoring
Elinzanetant:
- FDA approved 2025
- Also non-hormonal
- May help with sleep as well as hot flashes
- About 74% reduction in moderate-severe hot flashes
These aren’t just “something to try”—they’re the first treatments that address hot flashes at the neurological source without involving hormones at all.
Other Non-Hormonal Approaches
SSRIs/SNRIs:
- Paroxetine is FDA-approved for hot flashes at low doses
- Important caution: Paroxetine and fluoxetine interfere with tamoxifen metabolism. If you’re on tamoxifen, use venlafaxine or escitalopram instead.
- Modest effect on hot flashes
- May also help mood symptoms
Gabapentin:
- Off-label use for hot flashes
- May help with sleep
- Often taken at bedtime
- Trigger identification and avoidance
- Temperature management
- Stress reduction
- Exercise
- Hypnotherapy has reasonable evidence for hot flashes
- CBT can help with coping
- Yoga and mindfulness for overall wellbeing
For Vaginal and Urinary Symptoms
Vaginal dryness and urinary symptoms are particularly common and distressing for cancer survivors—especially those on aromatase inhibitors, which drive estrogen even lower than natural menopause.
Vaginal estrogen may be an option. This surprises many women. Local vaginal estrogen—creams, tablets, rings—has minimal systemic absorption. Blood estrogen levels stay very low. For many breast cancer survivors, oncologists now consider low-dose vaginal estrogen acceptable, especially for significant symptoms.
This is not a blanket statement—it depends on your specific situation and your oncologist’s assessment. But “I’ve had breast cancer” doesn’t automatically mean you can never use vaginal estrogen. Ask the question.
Non-hormonal options for vaginal symptoms:
- Ospemifene (Osphena)—oral SERM for vaginal dryness; discuss with oncologist
- Vaginal moisturizers (used regularly, not just during sex)
- Lubricants (for sexual activity)
- Hyaluronic acid preparations
Working with Your Medical Team
Your menopause care needs to be coordinated with your oncology care. This means:
Talk to your oncologist specifically about menopause. Many oncologists focus on cancer treatment and may not proactively address menopausal symptoms. Bring it up. Ask what’s safe for you specifically.
Find a menopause specialist who understands cancer history. Not all do. Some menopause providers aren’t comfortable treating cancer survivors; others specialize in it. A NAMS-certified menopause practitioner with oncology experience is ideal.
Don’t settle for “just deal with it.” Cancer survivors sometimes get dismissed—told to be grateful they’re alive and just tolerate the symptoms. Your quality of life matters. Symptom management is real medicine. Advocate for yourself.
Having a cancer history adds complexity, not impossibility. Options exist. The new non-hormonal treatments are genuinely helpful. And your symptoms deserve attention—not dismissal.
Work with providers who understand both cancer and menopause. Push for answers beyond “no.” You’ve navigated something far harder than finding appropriate menopause care. You can navigate this too.