Menopausal hormone therapy in breast cancer survivors: A review

The use of menopausal hormone therapy (MHT) by breast cancer survivors remains controversial. While MHT is effective for the management of menopausal symptoms in the general population, its safety after breast cancer is uncertain due to limited and heterogeneous data. Menopausal symptoms, including vasomotor and genitourinary complaints, can significantly impair quality of life and adherence to therapy. Non-hormonal treatments are the first-line option but are often insufficient. Evidence suggests that low-dose vaginal estrogen can relieve genitourinary symptoms with minimal systemic absorption and without clear evidence of increased recurrence risk. In contrast, systemic MHT remains highly debated, with conflicting data confounded by differences in study design, hormone formulation, and patient selection. Management should therefore be individualized, balancing symptom severity, recurrence risk, and patient preferences. Until more definitive data are available, multidisciplinary collaboration and shared decision-making remain essential in optimizing quality of life while minimizing oncologic risk.