HRT and Gynaecological Cancer Risk: Separating Fact From Fear

World Menopause Day falls on 18 October, and one of the most common worries I hear in clinic is about HRT and cancer risk. Many women avoid hormone replacement therapy, or stop it early, because of frightening headlines. The reality is more reassuring and more nuanced, and it varies from one woman to another.

Why HRT and cancer risk cause such concern

Much of the anxiety dates back to large studies published in the early 2000s, which were widely reported as showing that HRT caused cancer. Since then, the evidence has been re-examined in detail. We now understand that the type of HRT, how long you take it, your age and your personal history all affect the balance of risks and benefits.

HRT remains the most effective treatment for menopausal symptoms such as hot flushes, night sweats, poor sleep and low mood. It also helps protect against osteoporosis. For many women, these benefits are substantial.

HRT and womb cancer

Taking oestrogen on its own can cause the lining of the womb to thicken, which increases the risk of endometrial cancer. For this reason, women who still have a womb are prescribed combined HRT, which includes a progestogen to protect the lining. Women who have had a hysterectomy can usually take oestrogen alone. This is a clear example of how HRT and cancer risk depend on the type of HRT.

Taken correctly, combined HRT does not raise the risk of womb cancer in a meaningful way. However, any unexpected bleeding while on HRT, particularly after the first few months, should always be checked. Our page on post menopause bleeding explains why.

HRT and ovarian cancer

Some studies suggest a very small increase in the risk of ovarian cancer with HRT use. In absolute terms, the extra risk is low, and it appears to fall after HRT is stopped. When thinking about HRT and cancer risk overall, this is one factor to weigh alongside your symptoms and other health needs.

HRT and other cancers

Breast cancer is the part of HRT and cancer risk that most women ask about. Combined HRT is linked with a small increase in breast cancer risk, which rises the longer it is taken and falls again after stopping. Oestrogen-only HRT appears to carry little or no increase. Vaginal oestrogen, used for dryness and discomfort, does not appear to raise cancer risk in a meaningful way.

HRT does not increase the risk of cervical cancer, so keep attending your smear tests as usual. For perspective, lifestyle factors such as weight, alcohol and smoking also influence cancer risk, and Cancer Research UK explains the main causes of cancer clearly.

Weighing HRT and cancer risk for yourself

There is no one-size-fits-all answer to the question of HRT and cancer risk. Your doctor will consider your age, how long it has been since your periods stopped, your family history and any previous cancer. NICE guidance on menopause encourages doctors to explain the risks and benefits clearly, so that you can make an informed choice.

HRT after a gynaecological cancer

If you have had a gynaecological cancer, HRT may still be possible, depending on the type and stage of the cancer and the treatment you received. For example, it is often considered after early cervical cancer, and in some women after early womb cancer. Because HRT and cancer risk are so closely linked in this situation, specialist advice is essential.

Separating fact from fear

For most healthy women who start HRT before the age of 60, the benefits outweigh the risks. Understanding HRT and cancer risk properly means looking at your own circumstances rather than the headlines. Regular reviews, usually once a year, help make sure your treatment still suits you.

If you have questions about HRT and cancer risk, particularly after a gynaecological condition or cancer, please contact our team to arrange a consultation with Mr Abu. We will help you weigh up the options in the context of your own health.