The discussion around taking HRT after you have had breast cancer yourself is different from discussing additional risk of developing breast cancer from taking HRT if you have never had breast cancer.
Many of the current treatments used to treat breast cancer block oestrogen and cause a woman to experience menopausal symptoms. Women are often advised to stay on these medications for many years.
Unfortunately we do not have many studies looking at the risk of breast cancer recurrence when taking HRT and the studies we do have, have been criticised. However the studies we do have did show a small increased risk of recurrence of breast cancer in women taking HRT after breast cancer and current guidance is that HRT is contraindicated in women with a past history of breast cancer.
It is important to remember that a lack of solid evidence does not mean a lack of harm and the decision to take HRT following treatment for breast cancer needs to involve the cancer and breast teams and a menopause specialist. There may be changes that can be made to a woman’s current breast cancer treatment that on their own can improve menopausal symptoms.
Alternative therapies, both pharmacological (medication) and non-pharmacological can be very effective at managing menopausal symptoms and are usually recommended first line.
Vaginal irritation and dryness is a common symptom which can be quite disabling and may not respond to moisturisers and lubricants. In these circumstances a low dose of vaginal oestrogen can be extremely effective and is thought to be safe as barely any of the oestrogen is absorbed around the body.
An important message here is that every case needs to be managed individually as the type, stage and grade of breast cancer changes the risk of a recurrence along with the fact that the severity of a woman’s symptoms and response to other non-hormonal treatments varies. Shared decision making is vital and it is important that every women feels listened to and has the opportunity to fully explore treatment options and discuss the pros and cons with a specialist thereby feeling fully informed and comfortable with any decision that is made around treatment.
Occasionally a trial of HRT after breast cancer is the right decision for that individual due to the severity of symptoms and the impact of these symptoms on quality of life. This decision is generally made in a multi-disciplinary team setting after non hormonal options have been explored and the risks of HRT have been carefully outlined and discussed.