A breast cancer diagnosis can make decisions about hormone replacement much more complicated.
This is especially true for women who develop menopause symptoms after breast cancer treatment with chemotherapy, ovarian suppression drugs, anti-estrogen drugs, or other cancer treatments. These treatments can cause hot flashes, night sweats, poor sleep, vaginal dryness, and fatigue, affecting daily life and overall well-being. Women experiencing these symptoms may wish to discuss hormone options after breast cancer with a qualified healthcare professional to understand the potential benefits, risks, and alternatives available. The suitability of hormone therapy after breast cancer depends on factors such as cancer type, treatment history, and individual health risks, making personalized medical guidance essential.
This leads many breast cancer survivors to ask, can bioidentical hormones be used after breast cancer?
The answer is YES for most breast cancer survivors. Read this guide to learn in-depth about bioidentical hormones and factors to consider when using them for breast cancer survivors.
Can Bioidentical Hormones Be Used After Breast Cancer?
The possibility of using bioidentical hormones after breast cancer needs to be evaluated individually. Traditional mainstream oncology dogmaticaly avoids systemic hormone therapy in breast cancer survivors, for fear of inducing increased breast cancer recurrence. However, a 2022 review of the medical literature by Dr. Avrum Bluming reveals 26 studies of hormone replacement in breast cancer survivors. Of the 26 studies, 25 showed no increase in breast cancer recurrence. Of the 26, the only study to showing increased recurrence is the 2004 HABITS study by Dr. Lars Holmberg of Sweden. This HABITS study used the synthetic hormone, Norethisterone together with another synthetic hormone, Tamoxifen. This is a carcinogenic combination to be avoided since it caused a 300 percent increased breast cancer recurrence.
A detailed medical evaluation is important before making a decision on using hormone replacement.
What Factors Should Be Considered Before Using Bioidentical Hormones After Breast Cancer?
Several factors can influence whether hormone therapy is appropriate.
Type of Breast Cancer
Breast cancer is not one single type of cancer. There are cancer cell types that range from indolent (slow growing) to aggressive (fast growing) biologic behavior. That is why the pathology report from the excised specimen after biopsy of lumpectomy is very important and must be reviewed.
Your original pathology report from the biopsy or lumpectomy can provide information about:
- Estrogen receptor (ER) status
- Progesterone receptor (PR) status
- HER2 receptor status
- Status of Surgical Margins
- Status of Axillary Lymph Nodes
- Tumor characteristics
- Stage and grade of the cancer
- KI-67 staining which is a measure of proliferation rate
Hormone Receptor Status
Hormone receptor status is one of the most important factors to review when discussing bioidentical hormones after breast cancer. Normal breast cells have estrogen and progesterone receptors. A breast cancer which loses these receptors indicates a rogue cell type which tends to be more aggressive. Conversely a breast cancer which is positive for estrogen and progesterone receptors tends to be less aggressive (indolent) and have a more favorable histology. Triple negative breast cancers tend to be the most aggressive. A low KI-67 marker is more favorable, and high KI-67 over 20% indicates a more proliferative, more aggressive cell type. Unfavorable histology are things like triple negative for receptors, high KI-67, positive axillary lymph nodes, tumor extending beyond surgical margins, and multicentric tumors.
Your pathology report and hormone receptor status provides a window into the biology of your cancer cell type, whether favorable or unfavorable and gives us an estimate for probability of breast cancer recurrence.
Previous Breast Cancer Treatment
Your treatment history will be reviewed and is important for determining if there has been LTED, long term estrogen deprivation, which transforms estrogen from a growth signal to a death signal. Adjuvant endocrine therapy with estrogen blocking drugs such as tamoxifen or aromatase inhibitors mimic LTED and are important to consider. Adjuvant endocrine therapies with aromatase inhibitors make estrogen levels undetectable. Tamoxifen is an estrogen receptor blocker, and estrogen levels actually go up as the body compensates for lack of estrogen receptor activity. Both forms of anti-estrogen therapy cause severe menopause symptoms, a strong motivation to seek hormone replacement therapy.
Your physician may need to review whether you have previously received:
- Chemotherapy
- Radiation therapy
- Lumpectomy or mastectomy
- Ovarian suppression
- Tamoxifen
- Aromatase inhibitors
- Other endocrine or targeted therapies
For example, anti-estrogen treatments can produce significant menopause symptoms, the main reason for seeking hormone replacement.
Current Cancer Status and Follow-Up
Your current health status is another important consideration.
Does the patient have active disease or is the patient in remission or cured of disease? Patients with active breast cancer receiving cancer treatment from their oncologist are not good candidates for hormone replacement. On the other hand breast cancer survivors who have been surgically cured with lumpectomy or mastectomy with favorable histology on the pathology report are good candidates for hormone replacement with bio-identical hormones.
What Menopause Symptoms Are You Experiencing?
Breast cancer survivors seeking hormone replacement may have been to a long list of previous doctors, all of which refuse to treat them for fear of breast cancer recurrence. Women with severe menopausal symptoms interfering with sleep, work, relationships, and everyday activities are strongly motivated to seek out hormone replacement.
Common menopausal symptoms include:
- Hot flashes
- Night sweats
- Sleep disturbances
- Vaginal dryness
- Reduced sexual function
- Mood changes
- Fatigue
- Brain fog
- Joint discomfort
These symptoms are all relieved by a bioidentical hormone replacement program which relieves the menopausal symptoms and returns the patient back to normal life.
Which Bioidentical Hormones Are Being Considered?
The term “bioidentical hormones” means the chemical structure of the hormone is identical to the hormones present in the human body and are not synthetic or chemically altered. At the TruemedMD clinic, our medical director, Jeffrey Dach MD uses a combination of two estrogens called Biest, combined with natural progesterone and testosterone. They are each individually important and have different functions in the program. This is explained more completely in Dr. Dach’s book, Bioidentical Hormones 101, second edition.
The prescribing physician should consider:
- Which hormone formula is the safest and most effective.
- The proper combination of estrogen such as biest (80%E1 and 20%E2) with combined with progesterone
- All patients will be taking testosterone for its breast cancer prevention effects.
- The dosage used usually requires adjustment over time based on symptom relief.
- How the hormone will be administered, whether continuous or intermittent on a schedule.
- Follow up intervals and treatment monitoring.
What Other Health Factors Should Be Considered?
Breast cancer history is only one part of the evaluation. Your age and overall health is considered. Your physician may review your:
- Cardiovascular health
- Bone health
- Thyroid function
- Metabolic health
- Medications and supplements
- Family medical history
- Menopause history
- Current hormone levels when appropriate
What Should You Discuss With Your Doctor Before Starting Bioidentical Hormones?
Before considering treatment, make sure your physician has a clear understanding of your breast cancer history and current health status.
Useful questions include:
- What type of breast cancer did I have?
- Was my cancer hormone-receptor positive?
- What treatments have I received?
- Am I currently taking tamoxifen or an aromatase inhibitor?
- Which hormone or combination of hormones is being considered and why?
- What is the hormone formula and at what dosage?
- What are the potential benefits and risks?
These questions can help you understand the reasoning behind a proposed treatment plan.
How Jeffrey Dach MD Can Help With Hormone Management After Breast Cancer
At the TrueMedMD Clinic, our medical director, Jeffrey Dach MD, specializes in hormone replacement for the breast cancer survivor with attention to the all the details mentioned above, individual patient’s menopausal symptoms, medical history, breast cancer status whether active or in remission.
If you are considering bioidentical hormones after breast cancer, our practice can help you understand your hormone-related concerns, review relevant health information, and determine whether an individualized hormone replacement program would be appropriate for you.
Frequently Asked Questions
Can bioidentical hormones be used after breast cancer?
Yes, many gynecologists and oncologists such as Dr. Avrum Bluming feel that hormone replacement is beneficial for the breast cancer survivor, and it is time for the medical system to offer hormone replacement to breast cancer survivors. The best candidates are patients who are currently in remission with no active cancer, or surgically cured after lumpectomy or mastectomy. Favorable histology is a plus. Poor candidates are usually declined hormone treatment, such as those who still have active cancer under treatment by the oncologist. Other factors are to be considered are: cancer history, hormone receptor status, previous treatment, current symptoms, and the specific hormones being considered.
Does hormone receptor status affect the decision?
Yes. ER and PR status provide important information about the biology of the original breast cancer and should be reviewed when discussing hormone therapy.
Does the type of hormone matter?
Yes. Estrogen, progesterone, and testosterone have different functions. Jeffrey Dach MD’s published work also emphasizes the distinction between bioidentical hormones and synthetic hormone products. We avoid synthetic hormones which are carcinogenic and instead use natural hormones found in the human body.
Can menopause symptoms be treated after breast cancer?
Yes. Menopause symptoms are caused by estrogen deficiency and are best treated with bioidentical hormone replacement. We avoid synthetic hormones which can be carcinogenic.
Conclusion:
The medical literature on hormone replacement for breast cancer survivors shows this is beneficial with less breast cancer recurrence and improved health status. The TruemedMD clinic medical director, Jeffrey Dach MD has a special interest in hormone replacement for breast cancer survivors and is proud to offer this therapy in our office.
For more information see:
Bioidentical Hormone Replacement for Breast Cancer Survivors, Part One
Bioidentical Hormone Replacement for Breast Cancer Survivors, Part Two
