Hormone replacement therapy comes up in almost every menopause consultation, and so does the question behind it: does this raise my risk of breast cancer? The honest answer is that it depends on the type of hormone therapy, how it is taken, and your own history — it is not a single yes or no.
Large studies have shown that combined oestrogen-progestogen therapy is associated with a small increase in breast cancer risk after several years of continuous use, while oestrogen-only therapy, used by women who have had a hysterectomy, has not shown the same pattern in the same studies. The size of any increase, where it applies, is generally smaller than the risk difference from other everyday factors such as body weight, alcohol intake or a family history of breast cancer — context that headlines about HRT often leave out.
Local vaginal oestrogen, used for dryness and urinary symptoms, is a separate category again. Because so little is absorbed into the bloodstream, it is not treated the same way as systemic hormone therapy in the research on breast cancer risk. Confusing the two is one of the more common reasons women avoid treatment that could otherwise help.
None of this replaces an individual conversation. Your own risk depends on your age when starting therapy, how long you plan to use it, your family history, and any personal breast health history, and it is worth revisiting periodically rather than being decided once and left unreviewed.
See a doctor to review your personal risk factors before starting hormone therapy, if you have a personal or strong family history of breast cancer, or if you are already on HRT and have not had your regimen reviewed in over a year.