Medical Oncologist
Medicines
Fulvestrant, fertility, menopause and sexual health
Fulvestrant is mainly used after menopause, or with ovarian suppression in younger women, so periods usually stop during treatment. It can harm an unborn baby, so reliable non-hormonal contraception is needed. Vaginal dryness and lower desire are common but treatable. This page explains each area in plain language.
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Medically reviewed by Dr. Naresh GunduConsultant Medical Oncologist · MBBS, DNB (Internal Medicine), DM (Medical Oncology, AIIMS) · last reviewed September 2026, next review due September 2027
On this page
- How fulvestrant affects fertility, menopause and sex
- What fulvestrant means for your body and relationships
- Options for common concerns, in general terms
- The vocabulary, in plain language
- Honest realities about fertility and sex on fulvestrant
- If you had not reached menopause before treatment
- Raising sexual health with your partner and team
- Easing hot flushes, sleep and mood changes
- What people assume about fulvestrant and fertility
- Common questions about fulvestrant, fertility and sexual health
The short answer
How fulvestrant affects fertility, menopause and sex
Fulvestrant is a hormone injection used mainly for hormone receptor positive breast cancer that has spread or come back. It is licensed for women who have been through the menopause. When it is used for younger women who still have working ovaries, it is given together with ovarian suppression, such as monthly goserelin injections, which switch off the ovaries and bring on a temporary menopause. So for most women on fulvestrant, periods have either already stopped naturally or are stopped by treatment. Fulvestrant can harm an unborn baby, so pregnancy must be avoided during treatment and for a period afterwards, because the medicine stays in the body for a long time. Ovarian suppression does not work as reliable contraception, so women who could possibly conceive are advised to use a non-hormonal method such as a copper coil or condoms. Breastfeeding is also not advised during treatment. Fulvestrant blocks oestrogen throughout the body, which can cause vaginal dryness, lower sexual desire and discomfort during sex, alongside hot flushes. These changes are common and treatable, yet many people feel awkward raising them. Non-hormonal moisturisers, lubricants, pelvic floor physiotherapy and open conversations with a partner or counsellor can all help. Men who receive fulvestrant for breast cancer may also notice lower desire or erection problems.
Pregnancy must be avoided
Fulvestrant can harm a developing baby. Reliable contraception is needed during and after treatment.
Menopause is part of treatment for most
Either natural menopause or ovarian suppression means periods usually stop while on fulvestrant.
Sexual changes are common and treatable
Dryness, discomfort and low desire have practical solutions, and raising them is worthwhile.
This page gives general information only. Your oncologist can advise on contraception and sexual health in your situation.Key points
What fulvestrant means for your body and relationships
These four areas cover most of the questions people ask.
Fertility
Most women on fulvestrant are postmenopausal or have their ovaries suppressed, so natural pregnancy is unlikely but not impossible.
Contraception
Non-hormonal methods are preferred. Ask how long to continue after the last injection.
Oestrogen-containing pills are generally avoided.Menopause symptoms
Hot flushes, sweats, sleep problems and mood changes are common, especially with ovarian suppression.
Sexual health
Lower oestrogen action affects the vaginal tissues and desire.
Common changes
- Vaginal dryness and soreness
- Pain during sex
- Lower sexual desire
What may help
Options for common concerns, in general terms
Concern
Approaches often used
Preventing pregnancy
Copper coil or condoms, as advised by your team
Vaginal dryness
Regular non-hormonal vaginal moisturisers
Pain during sex
Water or silicone-based lubricants, slower pace, pelvic floor physiotherapy
Low desire
Addressing tiredness and mood, couple counselling, intimacy without pressure
Severe symptoms not helped by other measures
Individual discussion about low-dose vaginal oestrogen with your oncologist
Words you will hear
The vocabulary, in plain language
- Ovarian suppression
- Treatment that switches off the ovaries so they stop making oestrogen.
- Goserelin
- A monthly implant injection often used for ovarian suppression.
- Postmenopausal
- No longer having periods because the ovaries have stopped working.
- Vaginal atrophy
- Thinning and drying of the vaginal tissues due to low oestrogen.
- Copper coil
- A small device placed in the womb that prevents pregnancy without hormones.
- Pelvic floor physiotherapy
- Exercises and guidance that can ease pain and tension during sex.
Being straight with you
Honest realities about fertility and sex on fulvestrant
These are personal topics, and the answers are not always what people hope to hear.
Pregnancy is usually not advised
With advanced breast cancer on ongoing treatment, pregnancy is generally discouraged because of risks to both mother and baby.
Relief is often partial
Moisturisers and lubricants help many people, but some dryness or change in desire may remain.
Evidence on vaginal oestrogen is limited
Its safety alongside fulvestrant has not been fully studied, which is why it is a case-by-case decision.
What this page cannot tell you
It cannot tell you whether you could still conceive. Your team can assess your hormone status.
Talk to our team
Have a question about your situation?
Call the helpline or leave your details, and someone will help you arrange a consultation at the CION centre nearest you. One helpline serves every CION centre.
Call 1800 202 8726
Helpline open 24/7
Younger women
If you had not reached menopause before treatment
Younger women with advanced hormone receptor positive breast cancer face some extra decisions.
Why ovarian suppression is needed
Fulvestrant works best when oestrogen from the ovaries is switched off. Goserelin or a similar injection is usually given every month alongside it, or the ovaries may be removed.
After chemotherapy
Chemotherapy may have stopped your periods, but the ovaries can recover. Your team may check hormone levels rather than assume menopause.
Future family plans
If having children matters to you, say so early. The conversation is difficult, but it helps your team understand your priorities and discuss realistic options honestly.
Talking about it
Raising sexual health with your partner and team
Many couples in India find it hard to talk about sex, especially during cancer treatment. Yet these conversations often bring relief.
With your partner
Explain that changes are caused by treatment, not by a loss of love or attraction. Closeness, touch and time together matter as much as sex itself.
With your team
You can ask a nurse or doctor you feel comfortable with. Writing your question down can make it easier to raise.
Specialist help
Gynaecologists, pelvic health physiotherapists and counsellors can offer practical support.
Menopause symptoms
Easing hot flushes, sleep and mood changes
Menopause symptoms can affect intimacy indirectly, through tiredness, poor sleep and low mood. Easing them often helps relationships too.
Hot flushes and sweats
Light cotton clothing, a fan by the bed and avoiding spicy food, alcohol and hot drinks help many people. Non-hormonal medicines are available if flushes are troublesome.
Sleep
A cool bedroom, a regular bedtime and limiting screens and tea late in the day can improve rest.
Mood
Irritability, anxiety and low mood are common with sudden menopause. Talking therapies, exercise and, when needed, medicines can help. Tell your team if low mood lasts more than two weeks.
Bone health
Early menopause can thin bones, so your team may suggest a bone density scan, calcium, vitamin D and regular weight-bearing exercise.
Commonly believed
What people assume about fulvestrant and fertility
If periods have stopped, contraception is not needed.
Pregnancy can still occur in some women, so ask your team before stopping contraception.
Sex can make the cancer spread.
Sex does not spread breast cancer or affect how treatment works.
Any vaginal cream is fine to use.
Creams containing hormones need checking; non-hormonal products are preferred.
Loss of desire means something is wrong in the relationship.
Treatment, tiredness and low mood commonly reduce desire.
Questions we are asked
Common questions about fulvestrant, fertility and sexual health
How long should I use contraception after stopping fulvestrant?
Because fulvestrant stays in the body for a long time, contraception is advised for a period after the last injection. Product guidance recommends many months, and it differs between countries. Ask your oncologist for the exact advice that applies to you.
Can I breastfeed while on fulvestrant?
No. Fulvestrant may pass into breast milk and could affect a baby, so breastfeeding is not advised during treatment or for some time afterwards. Your team can advise on feeding options and how long to wait after the last dose.
Is it safe to have sex during treatment?
Yes, for most people. Sex does not affect the cancer or the treatment. If your blood counts are low because of a partner tablet, or you have pain from bone metastases, your team may suggest precautions or comfortable positions.
What lubricant should I use?
Water-based or silicone-based lubricants without perfumes or warming agents are usually gentlest. Regular vaginal moisturisers, used a few times a week, help with day-to-day dryness. Avoid oils with condoms, as they can damage latex.
Will my periods come back if I stop fulvestrant?
Fulvestrant itself does not switch off the ovaries. If your periods stopped because of ovarian suppression, they may return after that is stopped, depending on age and earlier chemotherapy. If you were already postmenopausal, they will not return.
Does fulvestrant affect men's fertility?
Men receiving fulvestrant, sometimes with medicines that lower testosterone, may notice lower desire and erection problems. Effects on sperm have not been well studied. Men who want children in future should discuss sperm banking before treatment where possible.
Can I use hormonal contraception like the pill?
Contraceptives containing oestrogen are generally avoided with hormone receptor positive breast cancer. Progestogen-only methods are also usually avoided. Copper coils and condoms are the methods most often recommended.
Who can I talk to about intimacy problems?
Your oncologist or breast care nurse is a good first step. They can refer you to a gynaecologist, pelvic health physiotherapist or counsellor. Many couples find that a single honest conversation with a professional makes a real difference.
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Sources
- MedlinePlus — Fulvestrant injection
- Breast Cancer Now — Fulvestrant (Faslodex)
- American Cancer Society — Sex and the woman with cancer
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.