A new expert consensus calls for a fundamental shift in how hormone replacement therapy (HRT) is offered to breast cancer survivors suffering severe menopausal symptoms. Published in Menopause on 30 September 2025 and reported by World Pharma News, this comprehensive review, involving UCL researchers and an interdisciplinary panel, urges clinicians to support informed, individualized decisions rather than blanket restrictions.

Breast cancer, affecting 2.3 million women worldwide each year, now boasts high survival rates thanks to modern treatments. However, many survivors endure intense menopausal symptoms, such as hot flushes, insomnia, mood swings, and genitourinary discomfort, either from their cancer therapy or natural menopause. For decades, HRT, the most effective remedy for these symptoms, has been largely withheld from survivors, especially those with estrogen receptor (ER)-positive cancers (the majority), due to fears that estrogen could fuel cancer recurrence. Current UK guidelines advise HRT only in “exceptional circumstances.”

The new review assembled 25 experts, including medical oncologists, menopause specialists, surgeons, radiologists, and patient representatives, to weigh up the latest evidence from clinical trials, observational studies, and real-world patient experience. After multiple rounds of voting and discussion, the panel agreed on 34 statements highlighting key evidence and recommendations.

Key Insights:

• Vaginal Estrogen: Products with minimal systemic absorption (e.g. vaginal oestrogen, DHEA) are unlikely to raise recurrence risk and can be safely used for genitourinary symptoms in survivors.
• Systemic HRT: While systemic HRT can increase the risk of relapse in ER-positive breast cancer—especially within the first 5–10 years post-diagnosis—this risk is nuanced. Most of the increase is for local recurrence or second breast cancers, which are often treatable. The rise in incurable “distant” relapse is relatively small.
• Risk in Context: Among women with moderate-risk disease, HRT raises the 7-year relapse rate from 14% to 20%. For low-risk women, the risk goes from 5% to 7.2%. In both groups, most women do not relapse, even if they take HRT.
• Shared Decision-Making: The panel strongly advocates moving away from a “de facto ban.” Instead, clinicians should help women understand their personal risk profiles and support them in weighing the benefits of symptom relief against the potential increase in recurrence risk.
• Future Research: The panel recommends enrolling women considering HRT after breast cancer in clinical trials, such as the proposed MENO-ABC trial, to gather robust, long-term data on outcomes.

Lead authors Professor Jayant Vaidya and Dr Sarah Glynne emphasize that for some women, the improvement in quality of life from HRT may outweigh the increased risk, especially when the risk is low or moderate. “Women should be able to talk to their clinicians and understand the estimated risk to them personally,” Glynne says, advocating for a nuanced, individualized approach.