If you’re in your mid-forties or older, it’s likely you’re experiencing symptoms of perimenopause or menopause. Many women experience fatigue, trouble sleeping, brain fog, night sweats, and hot flashes, all affecting their energy levels and mood. It’s a noticeable difference in how you feel both physically and mentally, that may seem like “just a part of life.”

Hormone replacement therapy (HRT) is one option to balance hormone levels so you can start feeling like yourself again and protect bone health. Yet despite how commonly it’s used, many women still feel uncertain about HRT because of an assumed increased risk of developing breast cancer.

While HRT may increase the risk of breast cancer for some women, today’s research suggests the relationship is more complex than previously thought and involves multiple factors. Having thoughtful conversations with a healthcare provider can help you navigate this decision.

We believe women deserve clear and balanced information so they can make confident decisions about their health. Here’s what to know about HRT and breast cancer risk.

What Is Hormone Replacement Therapy?

Hormone replacement therapy, or HRT, is a treatment designed to replace hormones such as estrogen and progesterone that decrease during perimenopause and menopause. It is not the same as hormone therapy used for cancer.

HRT can be administered by various healthcare providers, including primary care physicians, gynecologists, and endocrinologists. Treatment plans are individualized based on symptoms, blood test results, age, medical history, and overall health goals.

There are two main types of hormone-replacement therapy:

• Estrogen-only therapy
• Combined hormone therapy, including estrogen and progestin

Hormone therapy can be delivered in several forms, including pills, creams, gels, sprays, patches, or pellet inserts.

Why Women Consider HRT

Menopause affects every woman differently. While some women experience mild or occasional symptoms, others struggle with persistent discomfort or sleeplessness that makes getting through the day a challenge.

Many women opt for hormone replacement therapy because it can help alleviate symptoms such as:

• Hot flashes and night sweats
• Mood swings or irritability
• Low energy levels
• Brain fog or difficulty concentrating
• Sleep disruptions
• Vaginal dryness or discomfort

HRT also supports bone health and reduces the risk of osteoporosis, which becomes more common after menopause due to lower estrogen levels.

Currently, hormone replacement therapy is one of the most effective treatments available for menopause-related symptoms. For many women, HRT can provide significant relief from the uncomfortable symptoms commonly associated with this transition.

Does Hormone-Replacement Therapy Increase Breast Cancer Risk?

A common concern women have about HRT is whether it increases the risk of breast cancer. Previous studies showed that increasing your estrogen levels was correlated with a higher risk of developing breast cancer. However, as of November 2025, new research shows that the risk is much lower than previously estimated.

Research indicates that some forms of combined hormone therapy may be linked to a slightly higher risk, particularly with long-term use. However, experts now agree that for most women, especially those using HRT for a shorter period of time or starting around the onset of menopause, the overall risk remains low. Importantly, estrogen-only therapy appears to carry less breast cancer risk for many women compared to combinations that include both estrogen and progestin.

Overall, experts now recognize that risk levels can vary significantly from one individual to another, depending on the specific therapy used. Many healthcare providers are adopting a more personalized approach to menopause treatment.

It is also important to remember that many other factors, besides HRT, can influence your breast cancer risk. This is why it’s essential to have one-on-one discussions with your physician.

Factors That Influence Your Personal Risk of Breast Cancer

Your individual breast cancer risk is influenced by more than just hormone replacement therapy. Doctors often consider several factors before recommending HRT, including:

• Age: Breast cancer risk increases as you get older
• Length of HRT use: Longer use may elevate risk compared to short-term use
• Personal medical history: If you’ve previously had breast cancer, endometrial cancer, or ovarian cancer, your doctor should consider the severity of the menopause symptoms to determine if the symptoms counter the slightly increased risk of breast cancer
• Family history: Genetics can impact your personal breast cancer risk
• Health and lifestyle: Factors such as smoking, alcohol consumption, exercise, diet, and weight also play a role

Learn more about breast cancer risk factors and genetics.

Because of this, discussions about HRT are very personal. What works for one woman might not be right for another, even if they experience similar symptoms. Your healthcare provider will help you weigh the potential benefits and risks based on your unique situation.

When HRT May Not Be the Best Option

While HRT is a safe and effective method for many women, it may not be suitable for everyone.

Traditionally, women with a personal history of breast cancer were not considered appropriate candidates for systemic HR due to concerns about the risk of developing breast cancer or experiencing breast cancer recurrence. However, more doctors are now recognizing that the benefits of HRT may outweigh the risk for some breast cancer patients or survivors who have severe menopausal symptoms, especially if it significantly improves their quality of life.

That said, certain women may want to avoid or carefully consider HRT if they have:

• A strong family history of breast cancer
• Specific genetic mutations linked to cancer risk
• A history of stroke or blood clots
• Other significant medical conditions

In these situations, your doctor may recommend non-hormonal treatments or alternative ways to manage menopause symptoms. Fortunately, there are several options available today for women who either need or want to avoid using HRT.

Alternatives to Hormone Replacement Therapy

Not every woman chooses HRT, and that’s okay. The right approach for you will depend on your personal experiences during menopause.

Some women find relief through various options, including:

• Non-hormonal prescription medications
• Vaginal lubricants
• Supplement use for women in menopause, including vitamins and minerals such as magnesium, Vitamin D and E, and B-complex vitamins.
• Lifestyle changes, such as exercise, dietary adjustments, better sleep habits, and stress management techniques

Talking with your doctor about your symptoms and goals can help you determine whether HRT or an alternative to HRT is best for you.

Questions to Ask Your Doctor About HRT

Whether you choose to use HRT is a personal decision. There’s no one-size-fits-all solution, and having an open conversation with your doctor can help you figure out what feels right for you.

Some helpful questions to ask include:

• What type of HRT would I be prescribed?
• How long should I consider using HRT?
• Are there non-hormonal alternatives I should consider?
• How could my health history influence my individual risk?
• Are there ways to monitor my breast health while on HRT?
• What benefits can I realistically expect?

Having these open conversations with your physician can help you feel more informed and confident rather than overwhelmed.

Making the Decision That’s Right for You

Menopause is a natural stage of life, and how you handle it is a personal journey. For many women, HRT is a safe option that offers meaningful relief from menopause symptoms, while for others, alternative options may make more sense. Either way, many options can provide the support you need when dealing with difficult symptoms. The most important step is to have an open, honest conversation with your care team to determine if HRT is right for you.