Hormone Therapy Considerations for Breast Cancer Survivors and High-Risk Women.

Menopause in breast cancer survivors and high-risk women is abrupt, severe, and treatment-induced. Hormone therapy remains the most effective treatment of vasomotor symptoms and genitourinary syndrome of menopause (GSM), but it is frequently avoided because of concerns about cancer risk. Randomized trial data support avoidance of systemic hormone therapy in breast cancer survivors, although risk varies by patient population and formulation. Nonhormonal therapies are effective options for vasomotor symptoms, and low-dose vaginal estrogen is safe for most patients with GSM. Management requires balancing oncologic risk with symptom burden, taking into account tumor biology, baseline risk, and patient preferences.