Hormone Therapy and Breast Cancer Risk: What Indian Women Must Know - Dr Manjula Anagani

Hormone replacement therapy (HRT) can offer relief for the uncomfortable symptoms of menopause, such as hot flashes, night sweats, vaginal dryness, mood changes and protect against bone thinning. Yet, trade-offs exist.

In India, with its varied healthcare access and genetic, lifestyle, and environmental factors, the decision to start HRT needs careful weighing of risks and benefits, especially in peri- and post-menopausal phases.

Understanding the risk

Oestrogen and progesterone are powerful hormones. When used together in HRT, they help counteract many effects of menopause. However, combined hormone therapy has been associated with a somewhat increased risk of breast cancer.

Oestrogen alone carries a lower risk, especially when used in women who have undergone hysterectomy (i.e. absence of uterus), but that does not mean the risk disappears entirely.

Risk appears to grow with longer duration of HRT use. Many sources suggest that the risk becomes more noticeable after 3-5 years of continuous therapy. Once HRT is stopped, risk tends to decline over time.

The way hormones are given (type, dose, route), a woman’s age, breast density, body weight, and family history all influence how large or small the risk becomes.

Indian context: differing challenges

Several factors change how breast cancer with HRT may play out in India.

Genetic background and breast density: Indian women may have different breast density patterns, which can affect mammographic detection and possibly risk. Family history of breast cancer remains a strong risk factor.

Screening practices: In many parts of India, breast cancer screening (mammography, clinical breast exams) is less frequent or catches cancer at more advanced stages.

That means by the time risk from HRT becomes clinically relevant, detection may already be delayed.

Lifestyle factors—such as overweight and obesity, diet, alcohol use, delayed childbirth, and shorter periods of breastfeeding can all influence baseline breast cancer risk. When combined with HRT, these factors may magnify risk.

Healthcare access and follow-up: Regular monitoring through breast imaging and check-ups can be harder to maintain in places with limited healthcare resources.

Delays in diagnosis, missed follow-ups, or inconsistent care can cause greater harm.

What safe protocols look like

Using HRT safely isn’t about avoiding it entirely, but about making careful choices and keeping close monitoring.

Individual risk assessment: Before HRT is advised, doctors need to review the person’s cancer history, both personal and family, along with breast density, weight, diet, and any health concerns like liver disease or blood clot risk.

Lowest effective dose for shortest reasonable duration: Use the minimal dose that relieves symptoms. Avoid extending combined hormone therapy beyond what is needed, if possible.

Choice of hormone formulation: Certain types of progesterone or progestogens are believed to carry a lower risk than others. The method of delivery, whether through skin patches, local application, or systemic therapy, can also make a difference.

Non-hormonal alternatives: When symptoms are mild or risk is moderate to high, non-hormonal options (lifestyle, phytoestrogens, vaginal treatments, non-hormone medications) merit consideration.

Regular screening and follow-up: Annual or biennial breast exams, periodic mammograms in women over the recommended age (or earlier if risk factors exist), and patient education about self-breast exams are critical. Any unusual breast changes should prompt evaluation.

Balancing benefits vs risks

HRT has clear benefits: relief of vasomotor (hot flush) symptoms, improvement in sleep and quality of life, maintenance of bone density, prevention of osteoporosis and potential fractures. In many women, these benefits may outweigh the incremental risk of breast cancer, especially when protocols are followed carefully.

Nonetheless, risk is not zero. Combined estrogen-progesterone regimens tend to carry a higher risk compared to estrogen alone. In women with prior breast cancer or very high risk (strong family history, genetic mutations), HRT is often avoided or used only under specialist supervision and only if symptoms are severe and other interventions have failed.

Key takeaways for Indian women

Before starting HRT, discuss personal risk factors (family history of breast or ovarian cancer, age at first childbirth, breastfeeding history, BMI, breast density).

Use the smallest effective dose for the shortest time necessary, particularly when taking combined hormone therapy.

Talk to your doctor about hormone types that have safer safety profiles and delivery methods that limit overall exposure.

Stay committed to regular breast health monitoring: screenings, being aware of symptoms, and promptly reporting any changes.

Adopting healthy habits like keeping a steady weight, eating more fruits and vegetables, exercising regularly, and cutting down on alcohol can lower the basic risk of breast cancer and may ease some of the added risk from hormone therapy.

Hormone therapy remains a valuable tool in managing menopausal symptoms and preserving bone health. For Indian peri and post menopausal women, safe HRT protocols centred on individualised care, vigilant monitoring, and making informed trade-offs offer a path that balances comfort and risk.

When decisions are made in partnership with knowledgeable physicians, the goal becomes preserving well-being without undue exposure to harm.

Disclaimer: The views expressed in this article are of the author and not of Health Dialogues. The Editorial/Content team of Health Dialogues has not contributed to the writing/editing/packaging of this article.