Breast cancer risk in peri- and postmenopausal women with a history of hormonal contraceptive use: A narrative review.

Breast cancer is the most common cancer among women worldwide, and its incidence is projected to increase substantially by 2050. As hormonal exposure is a key modifiable risk factor, understanding the impact of exogenous hormones-including hormonal contraception-is essential. Although hormonal contraceptives are primarily used during the reproductive years, they are increasingly prescribed to perimenopausal women for both contraception and symptom management. We conducted a structured literature review using Ovid MEDLINE, identifying studies on hormonal contraception and breast cancer risk, including cohort studies, case-control studies, meta-analyses, case series, and systemic and narrative reviews. Evidence indicates that current or recent use of hormonal contraception is associated with a modest, time-limited increase in breast cancer risk (relative risk 1.1-1.6), which generally returns to baseline within a decade of discontinuation. Relative risk appears similar across combined and progestin-only formulations, with longer duration of use conferring a slightly higher risk. Women with BRCA1/BRCA2 mutations require individualized counseling for informed decision-making, with benefits weighed against the minimal potential impact on breast cancer risk. Hormonal contraceptive use does not appear to significantly increase risk in those with a family history of breast cancer. In conclusion, current evidence supports a small, reversible increase in breast cancer risk with hormonal contraception. Clinicians should employ shared decision-making to contextualize this transient risk within the broader benefits of hormonal contraceptive use and women's overall goals for their reproductive health.