What you need to know about treating perimenopause or menopause symptoms if you have a history of breast cancer in your family
• Most breast cancers happen by chance
• Body identical progesterone, estradiol and testosterone have not been shown to increase the risk of breast cancer
• How weighing up your individual benefits and any risks of treatment is key
Many women will have a family history of breast cancer because it is a relatively common disease - a woman’s lifetime risk of getting breast cancer is 1 in 7. However, most women who have a close relative with breast cancer will never develop it themselves.
If you have a family history of breast cancer, you may be wondering what your options are for treating your perimenopause or menopause symptoms and whether being prescribed progesterone, estradiol and testosterone are associated with any particular risks for you. Your doctor will be able to advise you on your personal risk of inheriting breast cancer but it can also be helpful to read up as much as possible on the latest evidence-based research and information.
If you have already had breast cancer, please read my article A guide to menopause if you’ve had breast cancer.
What is my risk of breast cancer?
On my podcast, I spoke with US oncologist Dr Avrum Bluming about breast cancer and HRT. Dr Bluming reminded us: ‘The biggest risk factor for breast cancer, aside from gender, is age and the risk of breast cancer increases as age increases.’
Most breast cancers happen by chance. Only 5-10% of breast cancers are caused by an inherited faulty gene, while an additional 15–20% exhibit familial aggregation (occur more frequently in families) without a single identified high-risk gene [1,2].
Having a first-degree relative (mother, sister or daughter) diagnosed with breast cancer puts you in a higher risk group but many women, understandably, overestimate their level of risk. If you have a significant family history of breast cancer in your family, it might be worth testing if you have faulty gene (specifically BRCA1 and BRCA2) – your healthcare professional will be able to advise you according to your individualised risk.
What are the risks of taking body identical hormones for all women?
HRT and testosterone is usually the first-line treatment for symptoms of perimenopause and menopause [3] and for the vast majority of women, the benefits from taking HRT outweigh any risks. The risks of HRT depend on the type of hormones you are prescribed – the risks of hormones are with synthetic (chemically altered hormones) and not with natural (body identical hormones). This means that there are also risks with hormonal contraceptives as these all contain synthetic hormones.
Some studies have shown that women taking combined HRT containing both estrogen and a progestogen (which is a synthetic progesterone) may be associated with a very small increased risk of breast cancer [4].
RELATED: Synthetic and natural hormones: what’s the difference?
The increased risk is related to the type of progestogen in the HRT and not the estrogen. Taking micronised progesterone (the body identical progesterone) has not been shown to be associated with an increased risk of breast cancer.
Even for women taking synthetic progestogen, the risk is very low and is less than the increased risk of breast cancer associated with drinking a couple of glasses of wine each night, doing no exercise or from being overweight [5].
Women taking estrogen-only HRT have been shown to have a lower future risk of developing breast cancer compared to women not taking any HRT.
RELATED: What does the evidence say about breast cancer and HRT? With Professor Isaac Manyonda
Should I take HRT if I have a family history of breast cancer?
There is no strong evidence that having a family history of breast cancer puts you at any higher risk of getting breast cancer if you take body identical HRT, compared to women who do not have a family history of breast cancer.
There is some evidence that women with a family history of breast cancer who take HRT have a lower future risk of developing breast cancer compared to women not taking HRT. [6]
This means that women with a family history of breast cancer, including those women with a BRCA gene, can still usually take HRT safely. As there are many health benefits of taking HRT, women can usually take HRT for ever, so do not have to stop taking it at a certain age or after a specific length of time.
Taking HRT and testosterone can improve perimenopausal and menopausal symptoms, and also reduce future risk of diseases. This should be considered when discussing your individual benefits with your healthcare professional.
You should also consider any other health conditions in your family, such as a history of osteoporosis – you are more likely to have osteoporosis if one of your parents has broken a hip for example. Estradiol (estrogen) HRT is licensed as a treatment to prevent osteoporosis. Women who take HRT also have a lower future risk of diabetes, coronary heart disease, clinical depression, dementia and some cancers [7].
RELATED: Can HRT and testosterone prevent osteoporosis?
As Dr Bluming points out: ‘What’s most important to remember is the overwhelming majority of patients who take HRT do not develop breast cancer, and the overwhelming majority of breast cancer patients never took HRT.’
RELATED: Getting to the truth about HRT and breast cancer with Dr Avrum Bluming
What else should I consider?
If you are at high risk of developing breast cancer, sometimes having surgery to remove your ovaries may be suggested to remove this risk. Having this before menopause is known as prophylactic ovary removal, and sometimes is referred to as a risk-reducing surgery. In this situation, it is important to have discussion with a menopause specialist beforehand about taking hormones after your surgery [8].
RELATED: ‘I had an early surgical menopause’
Finally, some of things you can do to lower your risk of breast cancer include:
¬- Staying a healthy weight
- ¬Taking regular exercise
¬- Not smoking
¬- Limiting alcohol to as little as possible
RELATED: Healthy eating for perimenopause and menopause
And remember to look at and feel your breasts regularly, to check for anything that’s different to normal, and to attend a breast screening appointment when you are invited.
