A new research review published in Maturitas concludes that there’s not enough evidence to determine if menopausal hormone therapy (MHT) can be safely used after breast cancer, highlighting the complex balance between quality of life and cancer risk faced by survivors.
Menopause is common after breast cancer, often triggered or worsened by chemotherapy or endocrine therapy. Symptoms such as hot flashes, sleep disturbance, vaginal dryness, bone loss and cognitive changes can significantly affect long-term health and quality of life. Hormone therapy remains the most effective treatment for many of these symptoms, but its use in breast cancer survivors has long been controversial.
The review notes that doctors and patients have traditionally avoided MHT in this group because of concerns about cancer recurrence, especially for hormone receptor–positive disease. Earlier randomized trials suggested hormone therapy could increase recurrence risk, while observational studies often found no increased risk or even suggested potential benefits. This conflicting evidence has contributed to ongoing uncertainty in clinical practice.
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According to the authors, evidence specific to breast cancer survivors remains limited and difficult to interpret due to small study sizes, varying treatment regimens and differences in follow-up. Many studies include mixed patient populations and different hormone therapy formulations, making it hard to draw firm conclusions.
Despite ongoing safety concerns, the paper highlights the significant unmet need for better management of menopausal symptoms after breast cancer. Non-hormonal treatments are available but are generally less effective than hormone therapy, leaving many women with persistent symptoms that affect daily life and wellbeing.
The review notes that decisions about MHT in breast cancer survivors should be individualized and made with careful discussion between patients and healthcare providers.
“Further high-quality, modern trials are urgently needed to clarify the safety of systemic and local hormone therapies in this population,” the authors wrote. “Until then, multidisciplinary, shared decision-making remains essential to balance symptom relief and risk of BC recurrence with long-term oncologic outcomes.”
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