Hormones after Breast Cancer, Can you take them?

Johanna breaks down one of the most misunderstood conversations in women's health — hormones after breast cancer.  Johanna unpacks what the research actually says about HRT, why so many women are told "no" without explanation, and why suffering through a decade of treatment side effects in silence is not the only option.

🎯• Dr. Tyna Show Episode 218: Hormones After Breast Cancer with Dr. Corinne Menn

🎯• Dr. Menn’s website: drmenn.com

🎯• Dr. Menn on Instagram: @drmennobgyn

🎯• Menopause After Cancer Clinician Directory: drmenn.com

🎯• Book: Estrogen Matters (Bluming & Tavris)

Transcript

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Middle has come in honey or nobody's fall.

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Hey friends, and welcome back to Not Your Mother's Midlife. I'm Joanna. If you're new here, this is a show where I listen to other podcasts and when I find them interesting, I dig into a little bit of the research and share and then share the podcast with you. Just listening to conversations and experts that are actually changing the way we think about midlife health. And today's episode is one I've been wanting to do for a while. If you've had breast cancer or at high risk for it, can you ever use hormone therapy? Is it automatically off the table? And if your doctor says no, full stop, is that actually based on current science? Well, I recently listened to a really interesting episode on the Dr. Tina show. You've heard me talk about her quite a bit on on this podcast because she's amazing and she does really great in-depth um interviews and information on different subjects to do with menopause, perimenopause, just female health in general. But she sat down with Dr. Corinne Men, a board-certified OBGYN, a menopause society certificate practitioner, and a 23-year breast cancer survivor herself. That's what I found most interesting and compelling is that she survived breast cancer and now she's doing research and helping other women. I wanted to share what I took from the conversation because it was hopeful and different than what I thought I knew about taking hormones after surviving breast cancer. And I think you'll like it too. So Dr. Men was 28 years old, she a second year OBGYN resident when she was diagnosed with stage 2A breast cancer, six weeks after her mother had suddenly died of ovarian cancer. So she went through chemotherapy, was thrown into abrupt premature menopause, and later discovered that she carries the BRCA2 gene mutation. She said nobody helped her with the menopause that chemotherapy caused. She was a doctor in a medical program surrounded by medical professionals, and this enormous piece of her health was just left unaddressed. That experience shaped her entire career. She now specializes exclusively in menopause management and breast cancer survivorship, and she's become one of the most respected voices on the topic. Most of us have been taught that estrogen feeds breast cancer. So if you've had breast cancer, the idea of taking any hormones sounds terrifying. And most doctors, even good ones, still reflexively say no. But Dr. Men talks about the Women's Health Initiative, the massive study that defined everything that we knew about HRT or hormone replacement therapy and breast cancer risk from the 2002 onwards. I did a whole um episode on that, so you can go back and listen if you want more in-depth, but we're not going to touch on all that here. And what she explains is that the data was catastrophically miscommunicated. The press conference happened eight days before doctors even saw the full study, and the fear that spread through the medical community was not what the data actually showed. The WHI actually found that estrogen alone used in women who'd had a hysterectomy was associated with a statistically significant reduction in breast cancer incidence. A reduction and a 40 to 45% reduction in breast cancer mortality over 18 to 20 years. Like I said, go back and listen to my episode on hormone replacement therapy and it goes more in-depth on that whole subject. It's very interesting and alarming. Anyway, as Dr. Men puts it, HRT has had the worst PR team in the history of medicine. The findings were real. The communication was a disaster. And the women have been paying the price ever since. I didn't know what breast cancer treatment actually did to women's hormonal health. So this was really interesting listening to this, because I found out a lot. And many women with hormone receptor-positive breast cancer, that's the most common type, prescribed inhibitors. These are drugs that block your body from converting other hormones into estrogen, dropping your estrogen levels by up to 95%. You take them every single day, typically for five to ten years. Think about what that means. Your body is running on essentially no estrogen for a decade. And estrogen doesn't just affect your reproductive system, it protects your bones, your cardiovascular health, your brain, your joints, your skin, your vaginal tissue. When it's stripped away completely and abruptly, the side effects can be very severe. Go back and listen to my the episode on hormones. And you'll learn a lot about why estrogen is so important. Okay, we're talking about hot flashes, night sweats, insomnia, joint pain, so significant that it feels like arthritis everywhere all at once, loss of bone density, cardiovascular changes, and real physical changes in the vaginal and urinary area that can make everyday life uncomfortable. Dr. Meng calls this GSM, gentinary syndrome of menopause, which simply means the vaginal and urinary changes that happen when estrogen falls. They're sent home with a prescription of aromatase inhibitors and almost no support for managing what those drugs do to their bodies. The cancer is being treated, the woman inside the body is being left to figure it out on her own. This is where Dr. Men is very careful because the answer is never the same for every woman. The short answer is it just depends. The type of breast cancer matters. Whether it was hormone positive or hormone receptor negative, that's what really matters. Your individual health, history, your risk profile, and your current treatment all matter. There's no universal yes or no to this. But she pushes back hard on the idea that the answer is automatically no for every single survivor. There is a growing body of evidence suggesting that hormone therapy after breast cancer does not worsen prognosis for many women. And she's clear that the conversation is far more nuanced than the flat nope, never, can't be dumb, that most women hear. She also discusses temoxifen, a medication commonly prescribed after hormone receptor-positive breast cancer. Instead of blocking estrogen reduction, tamoxifen acts like a bodyguard at the door of your cells, sitting on the estrogen receptors in breast tissue and blocking estrogen from getting in and triggering cancer cells' growth. Think of it like a key that fits the lock but doesn't turn it. It's usually taken daily for five to ten years and significantly reduces recurrence risks. The catch is that while it blocks estrogen in breast tissue, it can behave like estrogen elsewhere in the body, causing menopausal symptoms like hot flashes, mood changes, and vaginal dryness. But even for women who aren't candid candidates for systemic hormone therapy, there are options. Local vaginal estrogen applied directly to the vaginal tissues has been has not been shown to raise the risk of cancer reoccurrence and can make an enormous difference to the quality of life. Dr. Mann makes the point that this is something many breast cancer survivors could be offered but aren't, simply because their oncologists don't have the time or training to have that conversation. And let's make sure we're all on the same page about BRCA, because it gets thrown about a lot during these conversations, and I had to look it up. BRCA1 and BRCA2 are genes we all have, and their normal job is actually to suppress tumor growth. They're productive. They're helpful, they help us. But some people are born with a mutation in one of these genes, which means that protection doesn't work properly. If you carry one of those mutations, your lifetime risk of breast cancer and ovarian cancer is significantly higher. Breast cancer risk as high as 70% over a lifetime, depending on the specific mutation. Dr. Min addresses this personally because she herself is a BRCA2 carrier. Many women with a BRCA mutation used to have their ovaries removed to dramatically reduce their cancer risk. It works, but it throws them into surgical menopause, often in their 30s or 40s, very abrupt. There's no gradual transition. And here's what the research actually shows. For BRCA1 carriers who have had that surgery, hormone replacement therapy has not been found to increase breast cancer risk. And for women suddenly in menopause decades early, the long-term consequence of going without estrogen for their bones, heart, and brain can be really significant. This is one of the clearest cases where the benefit of HRT, hormone replacement therapy, can outweigh the risk. Dr. Men's message is this you do not have to suffer through this. Breast cancer survivorship is not just about surviving, it's about living. Too many women are white knuckling their way through a decade of treatment side effects in silence, accepting joint pain, insomnia, vaginal atrophy, depression as the price of being alive. This isn't inevitable. There are options. There are conversations worth having, and you deserve to have them. Here's what you can actually do with this. Don't minimize your symptoms. Everything that we've like listed above. Schedule an appointment with a menopause specialist, separate from your oncology checkups. Specifically to talk about your quality of life and your options. Come prepared with your questions written down and be specific about what you're experiencing and seek out someone who actually knows this space. Dr. Mann has a directory on her website, I'll list it in the show notes, for breast cancer survivors, and she's happy to help connect people with local resources at no charge. The conversation about hormones and breast cancer is not closed. The science is evolving all the time, and you deserve a doctor who will explore your individual situation rather than hand you a blank no. Like I said, I'll link Dr. Men's website, her Instagram, and the Dr. Tina Show episode in the show notes so you can check it all out. Um there's also a book that they recommend. It's called Estrogen Matters. As always, nothing on this episode is medical advice because I'm not a doctor. I'm a podcaster, and I'm a woman going through perimenopause. This is just me sharing expert conversations so you can go into your own appointments better informed. And have hope that you don't have to suffer in silence or alone. And if this episode resonated with you, please share it. Especially with anyone who's been through breast cancer or who's going through it now and is quietly struggling with what comes after. That's what I made it for. I made it for her. Until next week, I'm Joanna, and this is not your mother's medlife. Bye bye.