Olubukola Ayodele, Breast Cancer Lead at University Hospitals of Leicester NHS Trust, shared a post on LinkedIn:
” No. You can’t have hormone therapy.
It’s a phrase many women hear after a breast cancer diagnosis.
Clear. Definitive. Non-negotiable.
But what if that certainty is… overstated?
A recent paper in the Journal of Clinical Oncology is challenging one of the most ingrained messages in survivorship care:
- Menopausal hormone therapy (MHT) after breast cancer should not be an automatic “no.”
- It should be a personalised decision.
Because here’s what we don’t talk about enough:
For many survivors, menopause isn’t mild. It’s relentless.
Hot flushes that disrupt sleep night after night.
Cognitive changes that affect work and confidence.
Sexual dysfunction that impacts identity and relationships.
These are not “side issues.” They are quality of life.
And yet, in trying to reduce recurrence risk, we may have simplified the narrative too far.
The truth is more nuanced:
- Risk is not uniform — it depends on tumour biology and prior treatment
- Not all hormone therapies carry the same level of risk
- The evidence base is complex, and in places, uncertain
So the question becomes uncomfortable but necessary:
Are we protecting patients? Or are we protecting ourselves from uncertainty?
Because when the default answer is always “no,” we remove something fundamental:
CHOICE.
This paper doesn’t suggest we should start prescribing MHT freely.
It asks us to do something more difficult:
To have better conversations.
To acknowledge uncertainty.
To weigh risk AND lived experience.
To make decisions WITH patients, not just FOR them.
As oncologists, we are trained to prioritise survival, but survivorship is more than being alive.
It’s about dignity. Function. Identity.
And perhaps it’s time menopausal care received the same level of precision and individualisation as cancer treatment itself.
Would you feel comfortable having this conversation in your clinic?”