Menopause and Breast Cancer: Why HRT Can Be Safe for Many Women
Hormone replacement therapy is safe (and helpful!) for more women than previously thought
There has been no lack of discussion over the years about the link between menopause and breast cancer—particularly whether menopause and its treatment options are breast cancer risk factors. And while the two share commonalities such as prominence increasing with age and hormones being an important factor, it’s important to separate myth from fact.
Understanding the connection between menopause and breast Cancer Risk
First thing’s first: Changes in a woman’s body during menopause do not cause or increase the risk of breast cancer. In fact, menopause causes estrogen and progesterone levels to decrease, and many specific types of breast cancer are linked directly to estrogen as they use the hormone to grow.
That said, menopause occurs later in a woman’s life, and the risk of breast cancer also increases with age. Here’s how the two can potentially be connected:
Woman's World Answers
Age of menopause may impact breast cancer risk
When women go through menopause after age 55, there is longer-term exposure to hormones thought to increase breast cancer risk, explains Mindy Goldman, MD, Chief Clinical Officer at Midi Health, Clinical Professor in the Department of Obstetrics and Gynecology and Director of the Gynecology Center for Cancer Survivors and At-Risk Women Program at the University of California, San Francisco.
“There are recent studies, however, that have also shown that premature menopause— and in particular people who have infertility due to low ovarian reserve—may also have a higher risk of breast cancer,” she notes.
Breast cancer treatment can trigger menopause
If you’ve undergone breast cancer treatment, this can impact menopause and its symptoms in a variety of ways, says Dr. Goldman. For example, a treatment plan involving chemotherapy can affect ovarian function and cause either temporary or permanent menopause, she explains.
Additionally, breast cancer treatment may include surgical removal of the ovaries, and that can put someone into immediate surgical menopause, notes Dr. Goldman.
Two-thirds of breast cancers are sensitive to hormones, which means doctors will often prescribe hormonal therapies like tamoxifen or aromatase inhibitors to modify the tumor environment. These medications can cause menopausal side effects like hot flashes and vaginal dryness.
Can women at risk of breast cancer take HRT during menopause?
Menopause and symptom management may look different for women who have been diagnosed with breast cancer or are at high risk. One of the oft-discussed topics is hormone replacement therapy (HRT), a hormone therapy medication used to treat menopausal symptoms by releasing estrogen into the bloodstream or vaginal tissue.
Here’s what women at a higher risk of breast cancer (or who’ve have/had breast cancer) need to know about taking HRT during menopause:
HRT for women at high risk for breast cancer
“Those who are at high risk for breast cancer from factors such as having a family history of breast cancer are often told that hormone therapy is not something that they can do,” says Dr. Goldman. “We know that the bulk of evidence does not support this, meaning there is no evidence that the use of menopausal hormone therapy further increases breast cancer risk in those who are already at high risk.”
Still, it is imperative that women at high risk of breast cancer follow up closely and consistently with their medical team. This includes annual clinical exams, imaging including mammograms and potentially a breast MRI, she emphasizes.
HRT for women with breast cancer
The situation is a bit less straightforward for women currently living with breast cancer, particularly breast cancer that is sensitive to hormones (estrogen- or progesterone-positive breast cancer), explains Dr. Goldman. In these situations, the use of hormone therapy is typically avoided as the concern is that the therapy could potentially increase the risk of recurrence.
“This is a complex area as studies are really mixed as to whether this is actually true,” she acknowledges. “And the types of hormone therapy that are used nowadays are safer than those used years ago and may not increase breast risks in general.”
More specifically, she explains, most studies showing a higher risk of breast cancer with hormone therapy include synthetic progestins. Today, bioidentical formulations of progesterone are typically used, and there are studies suggesting that these formulations may not increase breast cancer risks.
The bottom line on breast cancer risk and HRT
The use of menopausal hormone therapy should always involve shared decision making, and someone who had breast cancer years ago may choose to accept the limitations of research in this area and opt for HRT to alleviate menopause symptoms, Dr. Goldman says.
“However, even for those who can’t take hormone therapy there are many other options available to treat symptoms,” she notes. “No one should feel that they have to suffer just because they have a diagnosis of breast cancer.”
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