Considering HRT in Women with Previous Breast Cancer

Author’s Note: This post is bound to bring about a variety of emotions attached to women’s health, current healthcare disparities, cancer, and more questions than answers. This post hits home as this author’s significant other was diagnosed with breast cancer caught early, successfully treated, and now after much research, discussion, and courage treated with HRT. This article is meant for informative purposes only. We educate to encourage dialogue between patient and provider. Any expert research mentioned here is for illustrative purposes.

How Misconceptions About ‘The Dangers of HRT’ Have Been Repudiated

In the late 1990s and early 2000s, HRT for females was common practice in the United States. It was the ultimate fix for hot flashes, mood swings, sleep issues, and wavering libidos. Then came a bombshell: the Women’s Health Initiative (WHI) study in 2002. 

It warned of increased breast cancer and heart disease risks, which stirred panic and nearly an overnight halting of prescriptions. What was lost is immeasurable: the physiologic protection, longevity and sexual-health benefits once afforded to millions lost to generations who came following.

Two decades later, a growing group of clinicians and researchers are rewriting that narrative, finding the WHI’s findings not only (knowingly) misleading, but potentially dangerous. 

Not only should a majority of women be given an opportunity to consider HRT. Even women with prior cancer diagnoses should not be left out of the discussion. 

Among the most compelling proponents is Dr. Avrum Bluming, an oncologist who’s been studying HRT in cancer survivors for 25+ years. Dr. Avrum Bluming is a clinical professor of medicine at USC and former senior investigator at the National Cancer Institute. 

He’s spent a good chunk of his career questioning mainstream ideas about estrogen and breast cancer—and backing it up with hard data. He co-authored the groundbreaking book “Estrogen Matters” with psychologist Dr. Carol Tavris, and he’s published several peer-reviewed studies arguing that the benefits of HRT often outweigh the risks, even in breast cancer survivors.

Dr. Bluming’s conclusion: estrogen saves lives (1). It supports bone density, cardiovascular health, cognitive function, and yes, quality of life. 

He expands on this in detail in his book, which covers in greater detail why taking hormones in Menopause can improve women’s well-being (2). 

We’re not just talking fewer night sweats, we’re talking fewer heart attacks and fractures. His work has concluded that the WHI study was misinterpreted. The original 2002 headlines overstated risk. 

Later analyses show that estrogen-only therapy actually lowers breast cancer risk. Even combined estrogen-progestin therapy, when tailored appropriately, does not increase mortality. Breast cancer survivors aren’t automatically disqualified from HRT. In a 2022 review published in The Cancer Journal, Bluming and colleagues evaluated 25 studies and found that only one (the HABITS trial) showed an increase in local recurrence, but more importantly, no increase in breast cancer deaths (3).

Rethinking our Fear of Estrogen

Another proponent of the important consideration of HRT for women even post-breast cancer is Dr. Corinne Menn, a gynecologist and a 23-year breast cancer survivor with a BRCA2 mutation, diagnosed in her twenties. 

She underwent a double mastectomy, chemotherapy, and surgical menopause by age 30. She could’ve just gritted her teeth and accepted the brutal symptoms of estrogen deprivation. But instead, she got curious, dug into the science, and became a leading advocate for individualized, evidence-based HRT, even in high-risk women like herself.

Dr. Menn now educates women and providers through webinars, podcasts, and patient courses. Her central message is that a one-size-fits-all approach to menopause care isn’t good enough, especially for cancer survivors.

Dr. Menn educates on the fact that vaginal estrogen is safe, even if a woman is on tamoxifen or aromatase inhibitors (estrogen blockers) (4). It doesn’t raise systemic estrogen levels and can dramatically improve quality of life for women dealing with painful sex or recurrent UTIs. More profoundly, systemic HRT isn’t automatically off the table. For women with early or surgical menopause, BRCA mutations, or completed treatment for low-grade breast cancer, systemic estrogen and sometimes testosterone and progesterone can be life-changing and safely used under the right care.

Symptom control is not a luxury, it’s a necessity. Women live decades post-cancer. Ignoring pre-, peri-, and post-menopause symptoms because of outdated fears does them a disservice.

Both Dr. Bluming and Dr. Menn point to a key scientific principle: the androgen/estrogen receptor saturation model. 

In plain English: hormone receptors in the body only respond to a certain amount of hormone. Once they’re saturated, adding more doesn’t keep “feeding” cancer growth—because there’s nowhere left for the hormone to bind. This model helps explain why low-to-normal hormone levels don’t necessarily increase cancer risk.

This is also why some providers (including urologist Dr. Ted Schaeffer) are even exploring testosterone replacement therapy in prostate cancer survivors (a story saved for a future blog post) (5).

Myth-Busting in the Menopause World

Myth #1: Estrogen causes breast cancer.
Fact: Estrogen-only therapy (used in women who’ve had a hysterectomy) lowers breast cancer incidence by 23% and mortality by 40%.

Myth #2: You can’t use hormones if you had cancer.
Fact: Many survivors, especially those with low-risk or treated disease, can safely use HRT under supervision, and data supports this.

Myth #3: Vaginal estrogen is dangerous.
Fact: Vaginal estrogen doesn’t raise systemic hormone levels and is considered safe by most professional bodies, even for those on anti-estrogen medications.

Myth #4: Menopause is just hot flashes and mood swings.
Fact: Untreated menopause can increase risk for osteoporosis, cardiovascular disease, cognitive decline, and metabolic disruption.

Personalized, Not Politicized: Where We Go From Here

The bottom line is this: hormone therapy, like all medicine, needs to be personalized. Dr. Bluming and Dr. Menn’s message is simple: Don’t fear hormones. Understand them.

This means we need to assess individual risk, symptom severity, educate providers away from 2002, and to not only empathize, but understand that menopause is more than a phase, but a span of life where misinformation should not rule, but an opportunity for vitality and optimized longevity. 

It’s time to take the conversation about hormones, cancer, and menopause out of the shadows. 

Thanks to trailblazers like Dr. Bluming and Dr. Menn, and with science by their side, more women are asking hard questions, demanding answers, and making decisions that reclaim their health and well-being.

Lucidity helps patients with HRT treatment. Check out our hormone replacement therapy subscription plans to learn more! 

Sources

1) Bluming AZ et al. “'Tis But a Scratch...” Menopause. 2023 Dec;30(12):1356–1359. (menopause treamtent)

2) Bluming AZ, Tavris C. Estrogen Matters. Little, Brown Spark; 2018. (estrogen matters)

3) Bluming AZ et al. “Hormone Replacement Therapy After Breast Cancer: It Is Time.” Cancer J. 2022;28(3):181–186. (hormone replacement therapy)

4) Menn C. Interview. Dr. Streicher’s Inside Information podcast. Ep. 59. June 2024. (menopause podcast)

5) Schaeffer EM. Interview. The Drive with Peter Attia podcast. Ep. 310. July 2024. (menopause treatment)