This article only offers a bit of information that was new to me, but as someone who had breast cancer treatment and so HRT is not recommended, it was nice to be represented in the discussion. https://www.nytimes.com/2026/06/15/well/menopause-hormone-therapy-breast-cancer.html?unlocked_article_code=1.rFA.tBAD.KI1xCCS3tTVf&smid=url-share
The article rubs me wrong. I don’t understand feeling “left out.” I understand feeling frustrated because you (“you” generally, not “you” anyone in particular on this thread) are having symptoms that aren’t being resolved, but I don’t understand looking at it like you’re being left out of some great, fun party. I went through an uneventful menopause during a time period in which HRT was out of fashion (and in fact, my mom’s HRT use may well have contributed to her breast cancer). Now that HRT is hot, I am not a candidate. I just don’t understand feeling left out, though. Again, frustration because an individual isn’t able to take something that helps many women isn’t really the issue … the issue is perhaps that with all the focus on one thing (HRT), alternative treatments are not being recommended (or perhaps not being researched?).
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I didn’t have any severe symptoms from menopause either but was the only one in my group of friends not on HRT - that fact was always met by shock whenever it came up. I went to a menopause specialist in my gyn group last year and we talked about bone & heart health, breast cancer risks, etc. I had my hormone levels tested, which were unsurprisingly on the low side. I decided to try a lower dose patch and see what I thought. The only difference I’m noticing is that my nightly leg cramps have disappeared, and that is huge for me because I had been to my PCP several times over the past few years for that issue. To the extent that it aids bone health is a bonus.
I’m not on testosterone and don’t think I need to add it, but I do have a good friend who added it to her HRT and said that she feels like a new person. She had been suffering from brain fog, and it was affecting her overall mood.
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I wouldn’t say HRT was ‘out of fashion’. A major HRT study (Women’s Health Initiative in early 2000’s) was misinterpreted by experts leading to confusion and controversy. This led to a significant decline in women taking HRT, some women were told to stop it cold turkey. Others who didn’t have many symptoms, were led to believe there were no other benefits to HRT beyond menopausal symptom relief, but now we know there are for many women.
The consequences of the WHI data misinterpretation were dramatic…women not getting relief of menopausal symptoms, or benefiting from a reduced breast cancer risk, or gaining bone density protection, or potential alzheimer’s protection, decreased HRT research funding and more.
While true that every woman has to make the best decision for their own healthcare, most look to their healthcare provider for direction. This is an example where many healthcare providers were wrong. Flat out wrong. And it’s persisted for two decades.
https://jamanetwork.com/journals/jama/fullarticle/2839211
This HRT debacle is another example of women’s healthcare not being a priority and/or not taken seriously, as someone mentioned above. This lack of care and focus is a documented systemic issue, with many studies demonstrating just that, all just a google search away. That could be a whole other thread.
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As an estrogen-positive breast cancer survivor for 18 years who was put into menopause at 48 by chemotherapy, my experience has been that any symptoms I would have liked relief for were brushed aside: “Brain fog? Vaginal atrophy? Bone density loss? Can’t sleep? Be glad you are alive.” And I am, but it’s been frustrating. I finally did find a doctor who would prescribe vaginal estrogen, but it was a fight, armed with articles from PubMed. Left out might be the wrong descriptor, but undertreated for issues that severely affected my quality of life for years is true. So, I am glad to hear that there are some newer treatments that are not hormonally based. And, when I see/hear folks waxing ecstatic about HRT it is annoying. I was just starting the years of estrogen-suppressing medication when a casual friend told me that I should go on HRT when I mentioned something about being forced into menopause. She had after a hysterectomy and thought it was the best thing. Yeah, no, that’s not going to work for me.
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One out of eight women get breast cancer and of those 80% are driven by hormones, I’ve read. ( I believe those stats were mostly based on an older population.)
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I was just thinking about this yesterday.
Nope, those (1 in8) are the current stats, based on everyone. Most women are older (older than 50) when they get BC but those who are younger often get a more severe/aggressive type.
One of the main treatments is hormone medication (tamoxifen, anastrozole) that suppress estrogen. That causes its own problems (that they may not tell you about). Caused trigger finger for me, and I just had hand surgery for that (even though I stopped taking anastrozole after 18 months because I hated it).
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What I meant was the population in that study skewed older. Regardless, I am not entirely clear why the caution about breast cancer after HRT has been removed.
I did 5 years letrozole for 5 years. I did a Breast Cancer Index test at year 5 that showed high risk of recurrence but no further benefit from continuing. Lots of lasting effects. Aromatase inhibitors are basically the opposite of HRT!
We should always first look to the data before we pass on things that we ‘have heard.’ There has been so much new data over the past twenty years wrt to HRT. As always, talk with your healthcare provider. If they aren’t up to date on the most recent recommendations, especially for one’s specific situation, get a new provider (if possible.)
- Some selected data from [well regarded] sources below, my emphasis in bold:
From BCRF .org
- Findings from the 20-year follow-up to the WHI study found that breast cancer risk increased with longer use of combination HRT, but absolute risk (the chance something will happen) was low compared to placebo, and women aged 50 to 59 had lower risk than women aged 60 and older.
- These findings are supported by another large study of women between the ages of 50 and 79 from the United Kingdom. In that study, researchers found higher risks associated with longer use of systemic combination HRT. However, short-term (less than five years) past use of combination HRT was not associated with an increased risk.
From Breast Cancer .org
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Systemic combination HRT and breast cancer risk
In women with no history of breast cancer who are over the age of 50, combination HRT taken for five or more years slightly increases breast cancer risk, according to Women’s Health Initiative studies and other research. Whether this risk applies to all women with no history of breast cancer over the age of 50, or whether there are some groups that might not have any increased risk at all, is controversial. Many experts agree, though, that any increase in risk is likely to be small.
Higher-dose combination HRT increases breast cancer risk more than lower-dose combination HRT.
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Systemic estrogen-only HRT and breast cancer risk
In women with no history of breast cancer, taking systemic estrogen-only HRT is not linked to a higher risk of breast cancer, according to the Women’s Health Initiative studies and other research. In certain groups of women, such as those who have no family history of breast cancer or benign breast disease, systemic estrogen-only HRT actually appears to lower the risk of breast cancer.
- The additional data available over the last two decades is what led the FDA to remove the black box warning on HRT in 2025:
- After findings from the Women’s Health Initiative were reported in 2002, a “black box” warning was added to many hormone treatments for menopause, cautioning that their use increased risks of uterine and breast cancer, stroke, blood clots, and dementia in women over 65. In November 2025, however, the FDA announced these warnings would be removed to better reflect the nuanced risk-benefit profile highlighted in follow-up studies.
- Most research suggests that the benefits of using HRT — such as improved quality of life and protection of bone health — outweigh the risks of these medicines for some people. That was the reason the FDA removed the “black box” warning from many HRT products in November 2025.
- There are mixed data and recommendations as to whether or not people who have had certain types of breast cancer should take HRT. Talk with your provider if you have had breast cancer. Not only does the type of the breast cancer matter, but also the treatment the person had, one’s general health, and even weight.
From breastcancer . org
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Systemic HRT for people with a breast cancer history
For people who have had a breast cancer diagnosis, there’s still some debate over systemic HRT and recurrence risk. A growing number of doctors and researchers now say that taking systemic HRT can make sense for some women with a breast cancer history.
In the past, many experts have said that women with a history of breast cancer should not take any type of systemic HRT (combination or estrogen-only) — especially if they had any breast tissue (so, anyone who didn’t have a double mastectomy). This is because there’s a risk that systemic HRT can cause breast cancers to develop, grow, or recur.
Only a few studies have been done on HRT use in women with a history of breast cancer. A 2021 analysis of four studies found that women diagnosed with hormone receptor-positive breast cancer who took systemic HRT had an 80% higher risk of recurrence than those who didn’t take HRT. Most of the concern has focused on women who have had hormone receptor-positive breast cancer, although it’s often the case that women who have had any type of breast cancer are advised not to take systemic HRT.
In recent years, however, more doctors are acknowledging that for some women with a history of breast cancer who have severe menopausal symptoms, the benefits of taking systemic HRT may outweigh the risks. In the journal Menopause in September 2025, a panel of experts recommended that some women with a history of breast cancer could choose to take systemic HRT to improve their quality of life, after discussing the risks and benefits with their doctor.
The panel pointed out that the increase in recurrence risk from HRT varies from person to person and that some people may decide to accept an increased risk of recurrence and death from breast cancer in exchange for improvement in their quality of life.
And Fabian notes that there is some research showing that in women who have had triple-negative breast cancer successfully treated in the past and had all their breast tissue removed (in a double mastectomy), taking systemic estrogen-only HRT won’t significantly increase their risk of recurrence. “I think estrogen replacement is safe for someone in that situation if they are several years from diagnosis and have no evidence of recurrence,” she says. “It’s especially worth considering if they were diagnosed with breast cancer at a young age and are having severe menopausal symptoms.”
BCRF is less nuanced wrt those with a history of breast cancer and HRT:
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Systemic HRT of any kind is not currently recommended for women who have a history of breast cancer. A 2021 review of systemic HRT in women with a history of breast cancer found that HRT significantly increased the risk of breast cancer recurrence, especially in patients with hormone receptor (HR)–positive disease, the most commonly diagnosed subtype of breast cancer.
Links:
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The aromatase inhibitors cause a number of musculoskeletal adverse effects, including trigger finger…these side effects are called aromatase inhibitor-associated musculoskeletal syndrome (AIMSS). From the article linked below:
- AIMSS is mainly comprised of AI-associated bone loss and arthralgias that affect up to half of women on AI therapy and detrimentally impact patient quality of life and treatment adherence.
- The reported prevalence of AIMSS varies widely in the literature but is estimated to occur in one-third to one-half of women utilizing AIs (30–32)
- AIMSS frequently leads to early discontinuation and nonadherence of AI therapy in a significant proportion of patients, which in turn has been associated with breast cancer recurrence and increased all-cause mortality (35)
Full discussion/data here:
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Yep, you can live longer if you take the drugs but who wants to live like that? I really didn’t get much push back from the oncologist when I said I wanted to stop.
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Yes, some treatments cause side effects which greatly worsen quality of life. H’s oncologist REALLY wanted him on testosterone suppression for prostate cancer for 2 years. H struggled to complete 6 months and told the oncologist that was all he could tolerate so reluctantly the oncologist and urologist agreed.
Doctors sometimes aren’t good at the whole picture & quality of life.
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My SIL went through a brutal regimen when dealing with breast cancer. She refused to finish her last chemo treatments. She completed the radiation and immunotherapy, but finishing the chemo was too much for her at 72 (and not in great health to begin with). Her H was upset with her, but she stuck to her guns & doesn’t regret it. It’s an individual call.
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H was 83 and we were getting ready for a 1 month trip to Scandinavia and he was just getting weaker & weaker and feeling awful. He recovered enough to have a pretty good trip.
We told the docs that no matter how hard we all tried, he’s not living another 40 years and wants to have some quality of life.
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By the way, apparently the correct terminology now is “hormone therapy,” not “hormone replacement therapy.”
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I’m curious to see what happens with the research on this- as usage has seemingly exploded in the last year or so. It seems like women are starting much earlier (40s) and will I guess plan to stay on them much longer- I have been on the fence, I’m mid 50s, still getting a period although not super regularly. I’m using the cream but nothing else yet. I’m not really having bad symptoms. I do have one friend who was an early adopter and was all in on hormones 10 years ago and subsequently had uterine cancer, fortunately she came through it ok. And impossible to know if hormones were a contributing factor or not. There is a fair amount of cancer in my family so I want to be really cautious.
The term “hormone therapy” is also used for aromatase inhibitors for cancer so that seems confusing!
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My 5 years of aromatase inhibitor treatment has led to 5 years of osteoporosis meds (Tymlos, Evenity, Reclast) after spinal fractures, which has meant 10 years of side effects. But I would do it all over again because I had my kids kind of late and want to be around as long as I can. Individual choices. Back in my 50’s I think I did a month or two of bioidentical hormones and had some sort of allergic reaction. I have wondered if that contributed to my cancer at 63.
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I’ve seen a couple of physicians on Instagram this week talking about a recent study published in the journal Urology. While the study was correlational, they included 1.9 million women with recurrent UTIs and found that those prescribed vaginal estrogen had markedly lower rates of hospitalizations, sepsis, and deaths. Here’s one link:
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