HRT and had breast cancer

[MinnieMountain]

I’ve been peri-menopausal for 4 years- a year after my treatment for hormone receptive breast cancer finished. I take tamoxifen.
I don’t take HRT as I got private advice at the time and was told it’s inadvisable.

I gather that advice has changed. Can anyone who had hormone receptive breast cancer and takes HRT tell me what you take and how you got your GP to prescribe it please?

I was told no never, it would be suicidal.

I was also told my sister, nieces and cousins should reconsider

And I was told that at a major teaching hospital and research centre this year

I’ve been told no never too, there are however other things you can use.
I have topical oestrogen cream to keep the worst symptoms at bay and there are certain antidepressants that reduce hot flushes.

That’s interesting. PPs on other threads where I’ve mentioned it have said they do take it.

There was a Danish study on topical oestrogen wasn’t there? Maybe I should ask for that.

A big fat no here too

HRT shouldn't be used if you have had breast cancer. It can be used if you have had a family history of breast cancer, depending on the specific circumstances, maybe that's what you're thinking of? You can use some vaginal preparations to treat vaginal symptoms, but that won't help with things like sweats and brain fog

I was told the same - no, never

Have to say I'm really struggling with some peri/meno issues at the mo but there's no way I'd risk it after such a strong message from my consultant who knew and understood my cancer

I had strongly oestrogen receptive breast cancer (7 years ago), and only just last summer my breast surgeon said no to HRT - but prescribed me oestrogen pessaries for vaginal atrophy. Tamoxifen threw me headfirst into immediate full blown menopause, it was horrendous.

Have a google of Louise Newsons stance on it - that’s where most of the quotes on the other threads come from, this will start you off - I’m not saying she’s necessarily correct but that’s where a lot of the new views come from.

www.newsonhealth.co.uk/wp-content/uploads/2021/07/Breast-cancer-and-HRT-Feb-22-update.pdf

www.balance-menopause.com/menopause-library/breast-cancer-and-hrt-factsheet/

I was told absolutely not. There is somebody on insta called The Hormone Doc (Annice Mukhergee) who has had BC and is full of good advice. Might be worth a look?

You are on tamoxifen to reduce the risk of breast cancer recurring. It works by reducing your hormones as your cancer responds to hormones. Of course you can't take HRT.

@aslkde there’s no need to be like that.

I’m well aware of the risks. I was asking because other posters have mentioned in passing recently that they have been prescribed HRT despite being hormone-receptive, so I was doing some digging.

And that you @Xrays .

I think - and disclaimer I’ve never had any experience of breast cancer - there’s a move in general for people to be able to weigh up their own risks and benefits with regards to medication, whereas in years before it would have been a flat nope. So for example even if there’s a risk of someone’s cancer returning by taking a certain treatment if it improves their quality of life in the meantime and they’re prepared to accept those risks then that’s up to them (I’ve got similar issues going on with my own treatments for lupus and other autoimmune issues I’ve got going on- one of the treatments is a chemotherapy drug).

Also - some of the internal oestrogen vaginal treatments (Ovestin and Vagifem) can be life changing in themselves- they were for me, I suffer with chronic painful bladder syndrome and vaginal atrophy due to early meno and for a long time I couldn’t take HRT systemically due to a prolactin secreting tumour. But I could still have Ovestin because it’s so low dose and doesn’t affect blood test results. So that may be an option for many people although it is part of HRT as such.

(I am now taking full HRT having seen a specialist in the nhs).

I was told no as well. There's Liz Riordan (I think that's the correct spelling) who posts on instagram about breast cancer and issues she was a doctor and has has BC twice herself, it may be worth seeing if she has posted anything.

She also posts on twitter

The overall advice is NO, but there are women who have chosen to go back to HRT as the quality of their lives are so bad.

One is Kirsty Lang (BBC Radio 4 presenter) and there are others like her.

She is interviewed on her decision here lizearlewellbeing.com/healthy-living/breast-cancer-hrt-kirsty-lang/

There is also a Youtube video of her talking about it with Dr Newson.

I think Kirsty Lang's article is really interesting, she has obviously weighed up the risks and made hopefully the right decision for her. Not easy and I imagine a lot of research and a great relationship with your doctors is needed. I think some women would probably prefer to hand over that decision making to the doctors whilst others are happier to take on that level of risk analysis themselves. It's good we seem to be moving to a less paternalistic model of medicine, but it's not for everyone.

Definitely not if you’re on tamoxifen.

Given that tamoxifen binds to and blocks oestrogen receptors HRT wouldn’t really work anyway!

And why risk adding oestrogen when you have/have had very recently an oestrogen receptive breast cancer.

There is some thinking that HRT may be used in women at least 5 years post treatment, not on tamoxifen and with a confirmed non-receptive cancer, usually initiated by a gynae oncologist.

I'm a GP with a particular interest in women's health, training to be a menopause specialist. You are very unlikely to get your GP to start HRT if you have had breast cancer - it's not an appropriate decision for most GPs, including those with an interest in menopause and wouldn't be safe. some menopause specialists will gather the info, talk to your oncologist and make a reasoned judgment about the risks and discuss that with you, so you can decide if you're happy with the risk/benefit balance. If you can afford it I'd see Sarah Gray in Cornwall privately as she's someone who will do this (she'll do remote) but be aware that your GP may not be happy to take on the prescribing, so you may have to continue getting the HRT privately.

"I gather that advice has changed."

would be interesting to know on what basis you gather this?

@Sidge
If you read the link I left to the interview with Kirsty Lang, a US oncologist says that women on Tamoxifen CAN use HRT as the tamoxifen stops estrogen affecting the breasts- it blocks it. (which is the point of Tamoxifen anyway.)

@MinnieMountain It's important to know that most experts now do not think estrogen causes breast cancer. wwwmenopausematters.blogspot.com/2016/04/hrt-and-breast-cancer.html

This is borne out by the fact that women using estrogen-only HRT have less breast cancer than women who don't use any HRT at all. Estrogen alone appears to be protective.

It's also been known for many years (I was told this by my consultant 15 years ago) that the type of progestin and the amount used is a factor and it's the progestin + estrogen that causes B cancer.

MPA and Norethisterone are the riskiest.

Recently, research has shown that micronised progesterone has no increased risk of BC for 5 years (this is all online by the way.)
It may even be risk-free for much longer (some studies in France and Denmark show no increase after 12 years.- no figures beyond that.)

So estrogen doesn't appear to cause BC but it will also potentially fuel any cancer cells left after surgery and chemo.

There are consultants who will prescribe HRT as ultimately, it's the woman's choice of quality of life over quantity.

One very eminent breast surgeon, Prof Michael Baum, has prescribed it for women for decades. www.dailymail.co.uk/news/article-10791467/Victims-breast-cancer-left-suffer-crippling-menopause-symptoms.html

Sorry it's a tabloid feature, but it gives the basics!

Not saying you should use it @MinnieMountain but this might give you the basis for a conversation with a consultant- NOT a GP who is not experienced enough to manage this type of issue.