Hormone therapy

HRT and breast cancer

After breast cancer, clinicians are told to stop systemic HRT and not to offer it routinely for menopause symptoms. Family history, and HRT after risk-reducing ovary removal, are separate decisions under NICE CG164.

By Ines Kovac. Published 22 October 2026. 5 minute read.

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Extra cases of breast cancer per 1,000 women, by HRT type and years of use, are for women with no personal diagnosis. Those figures are in HRT risks in plain numbers and the HRT risk picker. NICE, the NHS and the British Menopause Society are the UK sources, along with one statement from The Menopause Society. A clinician in the United States may follow different rules.

If you have had breast cancer: systemic HRT

When breast cancer is diagnosed, NICE tells clinicians to stop hormone replacement therapy taken as a tablet, patch, gel or spray. That follows the menopause recommendations in its guideline on early and locally advanced breast cancer (NICE NG23 recommendations).

NICE Clinical Knowledge Summaries list current, past or suspected breast cancer as a contraindication to prescribing HRT (CKS: HRT prescribing). They also say HRT should not be offered routinely for menopausal symptoms after breast cancer, once systemic treatment has been stopped at diagnosis (CKS: managing menopause).

The NHS puts that in patient language. If you have had breast cancer, you will usually be advised not to take HRT (NHS: benefits and risks of HRT).

A NICE draft of that breast cancer guideline advises against offering HRT routinely, including oestrogen and progestogen together, to women with menopausal symptoms after breast cancer. In exceptional circumstances, HRT may be offered for severe menopausal symptoms once the associated risks have been discussed (NICE draft guideline on early breast cancer).

The British Menopause Society classes a history of breast cancer as a contraindication to systemic HRT, and it puts non-hormonal options ahead of hormones (BMS recommendations on HRT).

For tablets, patches, gel and spray, read what hormone replacement therapy is and the forms it comes in. If a new diagnosis means a current prescription has to stop, how to stop HRT covers symptoms that can come back afterwards. If anxiety or low mood is what you want help with at that visit, use HRT, anxiety and low mood.

Hormone replacement therapy after breast cancer

Local care for dryness and pain during sex is a separate path in the November 2024 update of NG23. NICE says clinicians should offer non-hormonal moisturisers or lubricants to women with a personal history of breast cancer and menopause-related genitourinary symptoms.

If those symptoms continue, NICE says to consider vaginal oestrogen. The November 2024 text flags that use as off-label. Day-to-day use of moisturisers, lubricants and vaginal oestrogen is covered in vaginal dryness in menopause.

For people currently taking an aromatase inhibitor as adjuvant breast cancer treatment, NICE says to work with a breast cancer specialist on persistent genitourinary symptoms after non-hormonal treatments have been tried. That step is recommendation 1.5.16.

NG23 evidence review B2 treats systemic HRT as contraindicated for this genitourinary care, because oestrogen is absorbed into the bloodstream (NG23 evidence review B2).

The British Menopause Society says systemic HRT or vaginal oestrogen, when used for symptoms of low oestrogen, should follow a discussion with the breast specialist team (BMS: HRT before and after breast cancer).

NICE lists an open research question on whether vaginal oestrogen raises the chance of breast cancer coming back, or of a new breast cancer, in people who have had breast cancer or who have a high familial or genetic risk (NICE research recommendation on vaginal oestrogen).

Non-hormonal options after breast cancer

The Menopause Society's 2023 statement on nonhormone therapy reports Level I evidence that cognitive behavioural therapy eases bothersome hot flushes and night sweats in breast cancer survivors, and it recommends CBT for this group (The Menopause Society 2023 nonhormone therapy statement).

The hot flash relief finder sets out cooling, CBT, SSRIs and SNRIs, gabapentin, oxybutynin and fezolinetant. The survivor-specific rating in the statement above is for CBT.

The breast cancer draft also says not to offer soy isoflavones, red clover, black cohosh, vitamin E or magnetic devices to women with breast cancer who have menopause symptoms. An SSRI can be considered for hot flushes. For women taking tamoxifen, SSRIs are not recommended.

If St John's wort is used for hot flushes when breast cancer risk is high, or there has already been a diagnosis, NG23 warns of potentially serious interactions with other medicines, including tamoxifen, anticoagulants and anticonvulsants (NICE NG23 on complementary preparations).

HRT with a family history of breast cancer

HRT for a woman at familial risk is set out in NICE guideline CG164. Keep the course as short as possible and the dose as low as possible, and use oestrogen-only HRT where that is appropriate (NICE CG164: familial breast cancer).

The NHS page on oestrogen tablets, patches, gel and spray asks you to tell your doctor if you have ever had breast cancer, if you are having tests for breast cancer, or if you are considered high risk because of family history (NHS: who can use oestrogen).

Women with no personal diagnosis can look up the extra cases per 1,000 in the plain-numbers guide and the risk picker.

BRCA and risk-reducing surgery: when HRT is part of the plan

After risk-reducing removal of the ovaries and fallopian tubes before menopause, CG164 recommends offering HRT until the expected age of natural menopause. The average age it gives is 51 to 52. Women who still have a uterus are offered combined HRT, and women without a uterus are offered oestrogen on its own. This applies to women with a BRCA mutation or a similar family history who have not had breast cancer.

British Menopause Society fast facts say HRT can be used after prophylactic oophorectomy in BRCA1 or BRCA2 carriers, up to about age 50. After that age, the fast facts recommend avoiding HRT in this high-risk group (BMS fast facts: HRT and breast cancer risk).

Menopause that starts young, including when surgery is the cause, is covered in early and surgical menopause.

What to take to your appointments

When menopause symptoms follow a breast cancer diagnosis, or the risk is judged to be high, NG23 tells clinicians to offer information on all management options and a referral to a healthcare professional with expertise in menopause.

For treatment in that group, the same guideline points to the menopause section of the breast cancer draft, the risk-reduction section of CG164, and the NG23 section on complementary and unregulated preparations.

Bring a logged week from the hot flush diary for your GP, the menopause symptom checklist for your GP, and the questions to ask your GP about HRT. The diary and the checklist record how often symptoms happen. The questions are a way to ask about dose, duration and which specialists should be involved.

This is general information. Your own doctors decide whether to start, stop or change a medicine. Other HRT guides are gathered on the hormone therapy topic hub.

My take

At the start of the appointment, explain whether you have had breast cancer, whether surgery is planned for a BRCA mutation, or whether breast cancer runs in the family.

After a personal diagnosis I would start with CBT and the options on the relief finder, and I would want the breast team involved before any hormone therapy, including vaginal oestrogen. If the issue is family history, I would ask about the shortest time and the lowest dose in CG164, and whether oestrogen-only HRT is an option. After risk-reducing ovary removal, ask what age the team uses as the cut-off for HRT. CG164 and the BMS fast facts name different ages.