New Consensus Statement: Navigating Menopausal Hormone Therapy After Breast Cancer
A new international consensus statement has been released to help clinicians and breast cancer survivors better understand when menopausal hormone therapy (MHT) may be considered after breast cancer, and how to make safe, individualised decisions.
Many women experience significant menopausal symptoms after breast cancer treatment. Hot flushes, night sweats, sleep disruption, joint pain, sexual health changes and brain fog can profoundly impact quality of life. While lifestyle measures and non-hormone treatments can help, they are not always effective.
Systemic MHT remains the most effective option for vasomotor and other symptoms — but for breast cancer survivors, it has traditionally been contra-indicated because it may increase the risk of recurrence. Importantly, this risk is not the same for every woman. It depends on tumour biology, stage at diagnosis, and how long it has been since treatment.
The new consensus statement acknowledges that some women may choose to accept a small increase in risk in exchange for major quality-of-life improvements. The document aims to support clinicians and patients in making informed, shared decisions, rather than applying blanket prohibitions.
What determines the risk of using MHT after breast cancer?
The panel emphasises that three biological factors strongly influence recurrence risk — and therefore the potential impact of HRT:
1. Oestrogen receptor (ER) status
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ER-positive cancer is more likely to be stimulated by oestrogen.
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Because of this, women with ER+ tumours have a higher theoretical risk of a small cancer growing if exposed to systemic MHT.
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Risk is highest for those with strongly ER+/PR+ disease.
2. Cancer stage & pathology
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Larger tumours, lymph node involvement, and high-risk features (such as high grade) increase baseline recurrence risk.
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When baseline risk is higher, even a small relative increase from HRT can result in a more meaningful absolute increase — and this should be part of the discussion.
3. Time since diagnosis
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Recurrence risk is highest in the first 3–5 years after treatment.
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As time passes without recurrence, absolute risk generally decreases.
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However, ER+ cancers have a well-recognised risk of late recurrence, so time alone does not remove risk — it simply changes the conversation.
- Some cancer recurrences can switch receptor status.
Understanding these factors allows clinicians to estimate a woman’s individual baseline risk and explain how much HRT might change that risk in absolute numbers, not just percentages — a key part of informed consent.
What Does the consensus statement recommend?
A 25-member multidisciplinary panel reviewed the best available evidence on vaginal oestrogen, systemic MHT, and testosterone after breast cancer.
Their key recommendations:
1. Using vaginal oestrogen is acceptable
Local vaginal oestrogen can be used to treat genitourinary symptoms (dryness, discomfort, UTIs). Systemic absorption is extremely low, and it is considered safe for most survivors after an informed discussion with their oncology team.
2. Systemic MHT may be considered (off-label in specific cases)
Systemic MHT is not routinely recommended, but it is not absolutely prohibited.
It may be offered off-label when:
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symptoms are severe,
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non-hormonal therapies have been ineffective,
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and the individual’s risk–benefit profile is acceptable based on tumour stage, ER status, and time since treatment.
Some women will decide that even a small increase in recurrence risk is not acceptable. Others may prioritise symptom relief and quality of life.
3. Shared decision-making is essential
Decisions must consider:
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The woman’s symptoms and the impact on daily life
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Her individual estimated recurrence risk, based on tumour biology, pathology and years since diagnosis
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Her preferences, values and treatment goals
This process should be clinician-guided, documented, and ideally involve the oncologist or multidisciplinary breast team.
For years, discussions about MHT after breast cancer have been oversimplified. This consensus statement recognises the complexity — and the importance of patient autonomy, quality of life, and personalised risk assessment.
It encourages clinicians to:
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give clear, honest information
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calculate absolute (not just relative) risk
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acknowledge the woman’s values and priorities
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support her in making an informed choice
The panel hopes doctors and patients will use this framework to guide safe, collaborative decision-making.
Read the paper here
This information is for general educational purposes only and does not constitute medical advice. Please see your health professional for advice that is personalised to you.
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