HRT and Cancer

Hormone replacement therapy (HRT) is an effective way to manage the symptoms of menopause. However, if you have a history of cancer, you may feel left out of the menopause conversation, particularly if you have been told that you cannot take HRT. You may also be ready to explore treatment options but be worried about the risks of taking hormone-based medications.

The good news is that overall, HRT is incredibly safe to use. For those who have had cancer, you may even be able to use HRT under specialist guidance. If you can’t, there are many options available to you, which include optimising nutrition and lifestyle, non-hormonal medication and complementary therapies.

A work from the founder “Please be reassured that - whatever the course of action – you will be supported along the way to making your own, informed decision.” – Dr Naomi Potter.

Can HRT cause cancer?

HRT does slightly increase the risk of breast cancer, ovarian cancer and sometimes, womb cancer. However, the risk is small and, in most instances, the benefits in relation to managing menopause symptoms far outweigh the minimal risks.

The risk of cancer from using HRT depends on several factors including:

The type of HRT used
How long you take HRT for
Your age
Your general health and medical history

The risks explained

The relationship between HRT and cancer risk is complex and depends on several factors. Although small, the risk of cancer is slightly elevated with HRT, and it’s understandable if you want to understand the risks of this medication before you decide whether to start taking it.

The type of HRT used

There are different forms of HRT designed to replenish or balance out falling or fluctuating levels of oestrogen and progesterone. Some women will be prescribed oestrogen-only HRT, while others will be recommended a combined regimen of oestrogen and progesterone. There are also different forms of HRT, including tablets, patches, gel, spray, pessaries, cream, and vaginal rings. The type of HRT medication and the way it is delivered to the body make a difference in the risk of cancer it creates:

Combined HRT (oestrogen and progesterone): This type of HRT can increase the risk of breast cancer, particularly with long-term use. However, the risk decreases after stopping HRT, and over time, it returns to that of women who haven’t used it.
Oestrogen-only HRT: This is usually prescribed for women who have had a hysterectomy and is associated with a lower risk of breast cancer compared to combined HRT. However, it may slightly increase the risk of endometrial (uterine) cancer in women who still have a uterus.
Localised (low dose) HRT: Vaginal creams, rings, or tablets used to relieve symptoms like dryness and discomfort tend to have minimal effects and don’t carry the same cancer risks as orally ingested HRT.

How long you take HRT for

Generally, the risk of cancer, particularly breast cancer, increases with the duration of HRT use. Studies suggest that using combined HRT for more than five years may lead to a slightly higher risk, while shorter-term use carries lower risks.

Your age

Starting HRT before or around the time of menopause (typically between 45 and 55 years of age) tends to have few risks. It can actually come with some health benefits such as reducing the risk of cardiovascular disease and osteoporosis.

However, beginning HRT after age 60 may carry higher risks, especially for heart disease, stroke, and certain cancers. This is why it’s generally not recommended to start or continue taking HRT later in life unless there are compelling reasons.

Your general health and medical history

If you or a close family member have a history of breast, ovarian, or endometrial cancer, your doctor will carefully assess whether HRT is suitable. HRT may not be recommended in such cases due to potential increased risks.

Smoking, obesity, and lack of physical activity can also affect the risk of cancer and other serious side effects, with or without HRT. Maintaining a healthy lifestyle can help mitigate some of these risks.

Other conditions like blood clots or heart disease may also affect whether HRT suits you. For some women, the benefits of symptom relief may outweigh the risks, while others may be advised against it.

HRT and breast cancer

HRT can slightly increase the risk of breast cancer. According to the NHS, in every 1000 women who take combined HRT for five years, there are around five extra cases of breast cancer. The risk increases the longer HRT is taken but decreases once stopped.

This can make managing the symptoms of menopause and breast cancer more challenging given that HRT can increase the chance of breast cancer returning. That’s why if you have had breast cancer, you may be advised against taking it.

However, there are non-hormonal medications that can help manage the most common menopause symptoms. Hot flushes, for example, can be alleviated with Clonidine, Gabapentin or Venlafaxine, while vaginal dryness can be improved using vaginal moisturisers and lubricants.

HRT and ovarian cancer

Oestrogen-only and combined HRT can also increase the risk of ovarian cancer, particularly the two most common forms: serous and endometrioid. Again, the risk is small. It is thought that only 1% of all ovarian cancer cases are caused by HRT. An analysis of more than 50 studies found that women who took oestrogen and progestin (progesterone) after menopause did have an increased risk of getting ovarian cancer. However, when this risk was put into numbers, it equated to one extra case of ovarian cancer occurring in every 1000 women over 50 using HRT for five years. As with breast cancer, the risk is reduced when HRT is stopped.

Oestrogen-only HRT can increase the risk of endometrial (womb) cancer, with the risk becoming greater the longer the medication is used. This is why in most cases, this type of HRT is only recommended for women who have had a hysterectomy.

Can you take HRT if you have a family history of cancer?

Having a family history of cancer doesn’t automatically mean you can’t take HRT, but it does require careful consideration and consultation. If you have a family history of cancer, whether or not you can take HRT usually depends on several factors, including the type of cancer involved, the specifics of your family history, and your personal health.

A family history of breast cancer, especially if it involves close female relatives (like your mother or sister), is an important point when deciding on HRT. Research suggests that combined HRT can slightly increase the risk of breast cancer, however, a woman’s lifetime risk of developing breast cancer is 1 in 7, regardless of whether they take HRT or not.

If your family history suggests a genetic predisposition to breast cancer, such as BRCA1 or BRCA2 mutations, but you have not had breast cancer and are going through early menopause, The Royal College of Obstetricians and Gynaecologists advise on taking HRT until the natural age of menopause. This is because HRT medication can help minimise the risks linked to early menopause. If you have a history of breast cancer, then whether HRT is the best form of treatment is decided on a case-by-case basis.

A family history of cancers like colon or lung cancer is less likely to influence HRT decisions directly as these types of cancers are not as closely linked to hormone replacement therapy. However, if you have a genetic syndrome that increases your risk for multiple cancers, such as Lynch syndrome, your doctor will evaluate whether HRT is right for you.

Can you take HRT if you have previously had cancer?

Whether you can HRT if you’ve previously had cancer will depend largely on what type of cancer you had. If you’ve had breast cancer, for example, you’ll usually be advised not to take HRT as it can increase the risk of reoccurrence. Fortunately, there are effective alternative therapies for menopause.

Ultimately, the decision to take HRT requires a highly individualised approach. Your healthcare provider will assess:

Any specific types of cancer in your family history
Whether you have any genetic predispositions
The severity of your menopausal symptoms and how they impact your quality of life
Your general health, lifestyle, and any other risk factors

Knowing which doctor to consult for menopause can be invaluable in deciding how best to treat your menopause symptoms and whether HRT is right for you. At Menopause Care, we have a team of highly experienced menopause doctors and nurses who can talk you through your options and develop a personalised treatment plan based on your unique circumstances. To get started, book a consultation.

DisclaimerAt Menopause Care, we ensure that everything you read in our blog is medically reviewed and approved. However, the information provided is not meant to replace professional medical advice, diagnosis, or treatment. It should not be relied upon for specific medical advice.

References