The Benefits of Bioidentical Hormone Replacement Therapy: A Paradigm Shift for Breast Cancer Survivors

  When it comes to breast cancer and hormone therapy, many of us—both patients and clinicians—have been guided by fear rather than facts. Hormones, particularly estrogen, have been painted as the villain in the breast cancer story, blamed for everything from tumor growth to recurrence. But what if we’ve been wrong? What if we’ve been missing an opportunity to improve the quality of life for millions of women, including breast cancer survivors?

Picture this. A woman gets diagnosed with breast cancer. She is immediately thrown on a runaway train of doctors appointments, imaging, biopsies, surgery, chemotherapy, radiation, medicines and more medicines. By the time she looks up, it has been a year since she was diagnosed. She has had the year from hell. She is told she should be grateful to be alive. And she is. But it’s hard to feel grateful when you are tired, anxious, and depressed. You have trouble going to sleep, or staying asleep. You can’t remember words, names, or why you walked into the room. You have palpitations. Your joints ache. You’ve gained weight and feel unattractive. You have heartburn, belching, and gas. You have dry skin, dry hair, dry everything. You have a yeast infection that won't go away. You have no libido. Sex is painful and unwanted. Your relationship is suffering.


It’s hard to feel grateful.


And this woman, this forgotten woman, we all know her. She is the woman treated for breast cancer, yes. But she is also the woman who just went through menopause after the time of the Woman’s Health Initiative Study. Before that time, women were freely and liberally prescribed hormone replacement in perimenopause mostly for the purposes of preventing suffering.


That all changed in 2003.


This is a conversation I’m deeply passionate about, and it’s one that has gained momentum thanks to the courageous work of Dr. Avrum Bluming, co-author of Estrogen Matters. Dr. Bluming, an oncologist and researcher, has spent decades challenging the dogma that estrogen is dangerous for women, including those with a history of breast cancer. His work, combined with my own experiences as a breast cancer surgeon turned integrative oncologist, has reshaped how I approach hormone replacement therapy (HRT) in my practice.


Bioidentical Hormones: What Are They?


Bioidentical hormones are compounds derived from natural sources that are chemically identical to the hormones produced by our bodies. Unlike synthetic hormones, bioidentical hormones mimic the body’s natural signaling pathways, offering a gentler, natural, more precise approach to hormone replacement.


For women navigating menopause or its aftermath, bioidentical hormone replacement therapy (BHRT) can alleviate symptoms like hot flashes, brain fog, joint pain, sleep disturbance, and loss of libido. But its benefits extend far beyond symptom management—it also supports bone density, cardiovascular health, and overall vitality. For all women, including breast cancer survivors, this can be life-changing.


The Fear Factor: Estrogen and Breast Cancer


The belief that estrogen fuels breast cancer has its roots in studies like the Women’s Health Initiative (WHI), which caused widespread alarm when it linked hormone therapy to an increased risk of breast cancer. However, as Dr. Bluming has carefully detailed, these studies were flawed in their design and interpretation. Subsequent research has shown that the risks were overstated, and that estrogen may, in fact, play a protective role in certain contexts.


Dr. Bluming’s work reveals a more nuanced truth: not all estrogens are created equal, and not all women respond to hormones in the same way. For many breast cancer survivors, the careful reintroduction of bioidentical estrogen can improve quality of life without increasing recurrence risk. In fact, some evidence suggests it may even reduce the risk of future cancers by supporting overall health and immune function.


Why Consider BHRT After Breast Cancer?


As a breast cancer survivor, you may have been told to avoid hormones at all costs. But this approach often leaves women suffering and feeling abandoned in their post-cancer journey. Here’s how BHRT can make a difference:

1. Bone Health:
Estrogen plays a critical role in maintaining bone density. After menopause or cancer treatments like chemotherapy or any of the aromatase inhibitors, the risk of osteoporosis skyrockets. BHRT can help restore bone health and protect against fractures and bone loss.

2. Heart Health:
Cardiovascular disease is the leading cause of death in women, including those with a history of breast cancer. Estrogen has cardioprotective effects, supporting healthy blood vessels and cholesterol levels.

3. Cognitive Function:
Many women experience memory loss or “brain fog” after menopause or cancer treatment. Estrogen is vital for brain health, and BHRT can help restore mental clarity and focus.

4. Quality of Life:
Vaginal dryness, painful intercourse, loss of libido, fatigue, and mood swings are common complaints among breast cancer survivors. BHRT addresses these symptoms, empowering women to reclaim their sense of femininity and vitality.


Addressing the Risks


The decision to pursue BHRT is deeply personal, and it requires a nuanced, individualized approach. Not every woman is a candidate, and careful monitoring is essential. That said, the blanket rejection of hormones for breast cancer survivors is not supported by the latest evidence. Thanks to pioneers like Dr. Bluming, we have a growing body of data to guide us toward safe and effective hormone therapy options. I can tell you that for the first twenty years of my career, I too believed that hormone replacement should be reserved for those women that absolutely, positively could not live without it. I believed that coming from a breast cancer family, it was not possible for me. And then I read Estrogen Matters and it changed my life. Read it, and it may change yours too.


A New Paradigm of Care


As someone who has spent years in the trenches of breast cancer treatment, I know how overwhelming and isolating it can feel to navigate life after a diagnosis. For too long, we’ve been stuck in a fear-based approach that limits options and diminishes quality of life. It’s time to embrace a more integrative, evidence-based perspective.


Bioidentical hormone replacement therapy offers hope—not just for alleviating symptoms, but for restoring balance and vitality to women’s lives. Thanks to trailblazers like Dr. Avrum Bluming, we are rewriting the narrative around hormones and breast cancer. At Real Health MD, I am proud to stand at the forefront of this revolution, empowering women to make informed, confident choices about their health.


If you’re curious about whether BHRT might be right for you, let’s talk. At Real Health MD, we are committed to exploring all avenues to help you live a vibrant, empowered life—because surviving breast cancer is just the beginning. And survival isn’t the goal. Thriving is the goal.