{"id":484,"date":"2025-07-01T12:30:53","date_gmt":"2025-07-01T12:30:53","guid":{"rendered":"https:\/\/renewalhow.com\/europe\/hormonal-replacement-after-breast-cancer-whats-new\/"},"modified":"2026-06-25T23:07:07","modified_gmt":"2026-06-25T23:07:07","slug":"hormonal-replacement-after-breast-cancer-whats-new","status":"publish","type":"post","link":"https:\/\/renewalhow.com\/europe\/providers\/providers-blog\/hormonal-replacement-after-breast-cancer-whats-new\/","title":{"rendered":"Hormonal Replacement after Breast Cancer: What’s New?"},"content":{"rendered":"

Hormone replacement therapy (HRT) in menopause for women with a history of breast cancer remains one of the most complex and debated topics in gynecological endocrinology. For a long time, an extremely conservative approach prevailed, focused on the fear of recurrence. However, new evidence and guidelines now allow for a more personalized and balanced evaluation.<\/p>\n

Hormone replacement therapy (HRT) in menopause for women with a history of breast cancer remains one of the most complex and discussed topics in gynecological endocrinology. For a long time, an extremely conservative approach prevailed, focused on the fear of recurrence. However, new evidence and guidelines now allow for a more personalized and balanced evaluation.<\/p>\n

Understanding the complexity: the role of tumor biology<\/strong><\/h2>\n

Not all breast cancers respond the same way to hormones. Therefore, it is essential to understand the histology and molecular profile of the tumor:<\/p>\n

\n\n\n\n\n\n\n\n
Tumor subtype<\/strong><\/td>\nHormonal receptors<\/strong><\/td>\nImplication for HRT<\/strong><\/td>\n<\/tr>\n
Invasive ductal carcinoma ER+<\/td>\nER+\/PR+<\/td>\nContraindicates systemic HRT<\/td>\n<\/tr>\n
Pure HER2+ carcinoma<\/td>\nNo hormonal expression<\/td>\nCase-by-case evaluation<\/td>\n<\/tr>\n
Triple-negative (ER-, PR-, HER2-)<\/td>\nAbsence of receptors<\/td>\nGreater openness to discuss HRT<\/td>\n<\/tr>\n
Curable in situ carcinoma (DCIS\/LCIS)<\/td>\nDependent on subtype<\/td>\nMay be considered<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/figure>\n

What do the main evidences say?<\/strong><\/h2>\n
    \n
  • The CGHFBC meta-analysis published in The Lancet<\/em> (2019) noted an increased risk of recurrence with the continuous use of combined HRT in women with ER+ cancer.<\/li>\n
  • Isolated estrogen demonstrated much lower risk, primarily in women who have undergone hysterectomy.<\/li>\n
  • An integrative review published in 2025 (Acervo Sa\u00fade<\/em>) showed that the duration and type of hormone used directly influence this risk.<\/li>\n<\/ul>\n

    New guidelines: more individualization<\/strong><\/h2>\n

    The NICE (2024) and BMS (2024) guidelines propose a more flexible approach:<\/p>\n

      \n
    • Systemic HRT remains contraindicated in active or recent ER+ breast cancers.<\/li>\n
    • It may be discussed in cases of triple-negative or HER2+ cancer, cured many years ago, always with the approval of the oncologist and specialized team.<\/li>\n<\/ul>\n

      Vaginal estrogen: a safe option?<\/strong><\/h2>\n
        \n
      • According to NICE and BMS, low-dose vaginal estrogen does not increase the risk of recurrence<\/strong> in women with ER+ breast cancer.<\/li>\n
      • A study presented at ASCO 2025 showed that women over 65 who used vaginal cream showed reduced mortality<\/strong>.<\/li>\n
      • They may be indicated for urogenital symptoms such as vaginal dryness, dyspareunia, and recurrent urinary infections, always with multidisciplinary follow-up.<\/li>\n<\/ul>\n

        Practical tips for clinical practice<\/strong><\/h2>\n
          \n
        • Active or recent ER+ breast cancer: formal contraindication<\/strong> for systemic HRT.<\/li>\n
        • Triple-negative, pure HER2+, or cured DCIS: may allow individualized evaluation<\/strong>.<\/li>\n
        • Local low-dose vaginal estrogen: safe even in ER+<\/strong>, with oncologist approval.<\/li>\n
        • The therapeutic decision must be shared and multidisciplinary<\/strong>, considering risks, benefits, and the patient’s quality of life.<\/li>\n<\/ul>\n

          References:<\/strong><\/h2>\n
            \n
          • NICE. Menopause: identification and management (NG23). 2024.<\/li>\n
          • British Menopause Society (BMS). Consensus Statement, 2024.<\/li>\n
          • The Lancet. Type and timing of menopausal hormone therapy and breast cancer risk. 2019.<\/li>\n
          • Acervo Sa\u00fade. Hormonal therapy in menopause and breast cancer: integrative review. 2025.<\/li>\n
          • Reuters Health. Older breast cancer patients using estrogen cream live longer. 2025.<\/li>\n
          • The Times. Menopausal cancer survivors offered HRT under new guidance. 2025.<\/li>\n<\/ul>\n

            Article written by Dr. Francisco Tostes, Scientific Director at Renewal.<\/em><\/strong><\/p>\n","protected":false},"excerpt":{"rendered":"

            Hormone replacement therapy (HRT) in menopause, in women with a history of breast cancer, remains one of the most complex and debated topics in gynecological endocrinology. For a long time, an extremely conservative approach, focused on the fear of recurrence, prevailed. However, new evidence and guidelines now allow for a more personalized and balanced assessment.<\/p>\n","protected":false},"author":0,"featured_media":523,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_rwl_seo_title":"","_rwl_seo_description":"","_rwl_seo_noindex":"","footnotes":""},"categories":[23,21],"tags":[],"class_list":["post-484","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-clinical-practice","category-providers-blog"],"_links":{"self":[{"href":"https:\/\/renewalhow.com\/europe\/wp-json\/wp\/v2\/posts\/484","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/renewalhow.com\/europe\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/renewalhow.com\/europe\/wp-json\/wp\/v2\/types\/post"}],"replies":[{"embeddable":true,"href":"https:\/\/renewalhow.com\/europe\/wp-json\/wp\/v2\/comments?post=484"}],"version-history":[{"count":1,"href":"https:\/\/renewalhow.com\/europe\/wp-json\/wp\/v2\/posts\/484\/revisions"}],"predecessor-version":[{"id":522,"href":"https:\/\/renewalhow.com\/europe\/wp-json\/wp\/v2\/posts\/484\/revisions\/522"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/renewalhow.com\/europe\/wp-json\/wp\/v2\/media\/523"}],"wp:attachment":[{"href":"https:\/\/renewalhow.com\/europe\/wp-json\/wp\/v2\/media?parent=484"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/renewalhow.com\/europe\/wp-json\/wp\/v2\/categories?post=484"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/renewalhow.com\/europe\/wp-json\/wp\/v2\/tags?post=484"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}