Nakaka-cancer ba ang HRT? The real numbers, in plain words

If your Tita says "HRT causes cancer", she is not making it up. She is remembering 2002.

That year, the Women's Health Initiative (WHI), a large US trial, stopped its estrogen plus progestin arm early. Headlines around the world said HRT raised breast cancer, heart attack and stroke risk. Prescriptions dropped fast, and many doctors stopped offering HRT at all. In the Philippines, that belief stuck. A Filipina on Reddit put it this way: not everyone is open to HRT "for fear of cancer" (r/AskPinay).

What the headlines left out:

• The women in WHI were aged 50 to 79 and on average 63 when they joined, so many were years past menopause. Most women who want HRT today start in their late 40s or early 50s.
• WHI tested one specific combination: conjugated equine estrogens 0.625 mg plus medroxyprogesterone acetate 2.5 mg in one daily tablet. That is not the only HRT, or the most common one now.
• The risks were reported as percentages ("26% higher"), not as real numbers of women. Real numbers tell a calmer story.

Later analyses of WHI found that risk depends on age, how long after menopause you start, the type of hormone and the route (radar.ph summary).

In the WHI estrogen plus progestin arm, the excess was about 8 more invasive breast cancers per 10,000 women per year of use (Rossouw et al., JAMA 2002). The trial arm was stopped after an average of 5.2 years.

Put another way:

• Picture 10,000 women taking combined HRT for a year, and 10,000 similar women not taking it.
• About 8 more women in the HRT group would be diagnosed with breast cancer that year.
• That is under 1 in 1,000 women per year. The "26% higher" headline (a hazard ratio of 1.26) describes the same small difference.

The chart above uses a different, UK-based set of figures (women aged 50 to 59 over 5 years), but it makes the same point: the difference from combined HRT is small next to the whole group, and smaller than the difference linked to a BMI of 30 or more.

Two more things matter here. First, the risk with combined HRT builds with longer use. It falls after stopping, though a large 2019 analysis found some extra risk can remain for more than 10 years compared with women who never used HRT (MHRA). Second, a small rise in risk is not nothing, and some women will weigh it differently. That is a fair choice. The point is to make it with the real numbers, not the 2002 headline.

WHI also had an estrogen-alone arm for women who had a hysterectomy (no uterus, so no progestogen needed). Here, breast cancer was not increased. If anything it was a little lower, though in the first report the difference was not statistically clear (hazard ratio 0.77; Anderson et al., JAMA 2004).

The Menopause Society 2022 position statement says estrogen alone may lower breast cancer risk. Long-term WHI follow-up (over 20 years) pointed the same way: estrogen alone was linked to fewer breast cancers and fewer breast cancer deaths, while estrogen plus progestin was linked to more breast cancers (Chlebowski et al., JAMA 2020).

So why not give everyone estrogen alone? Because if you still have a uterus, estrogen on its own makes the womb lining grow, and that raises the risk of endometrial (womb) cancer. A progestogen prevents that. This is the one cancer warning the US FDA kept on systemic estrogen-alone labels in 2025. It is also why your doctor will insist on the progesterone part if you have a uterus. Do not skip it to "save money".

The Menopause Society (formerly NAMS) 2022 hormone therapy position statement is the main guideline most menopause doctors use. Its key points on safety:

• For most healthy women with bothersome symptoms who are under 60 or within 10 years of menopause, the benefits of hormone therapy are greater than the risks.
• Breast cancer risk with estrogen plus progestogen "does not increase appreciably with short-term use".
• Estrogen alone may lower breast cancer risk.
• Skin routes (gel, patch) and lower doses may carry lower clot and stroke risk.
• There is no need to stop routinely at 60 or 65. The decision is individual.

Read the press release.

On 10 November 2025, the US Food and Drug Administration announced it would remove the boxed warnings (the black-box warnings at the top of the label) for cardiovascular disease, breast cancer and probable dementia from menopausal hormone therapy products. It also recommended removing the old advice to use "the lowest dose for the shortest time". The boxed warning for endometrial cancer stays on systemic estrogen-alone products (RAPS).

This does not mean HRT has no risks. It means the US regulator decided the old warnings, written after 2002, overstated the risk for the women who usually use HRT today.

Two caveats for the Philippines:

• The change is for US labels. Product leaflets in the Philippines may still carry the older warnings, because label changes are rolled out product by product.
• The FDA Philippines makes its own decisions. We will update this page if local labelling changes.

No, on current evidence. The UK guideline NICE NG23, updated in November 2024, says HRT is unlikely to change overall life expectancy (Menopause Charity summary).

The 18-year follow-up of the WHI trials also found that HRT was not linked to a higher risk of death from any cause, heart disease or cancer (Manson et al., JAMA 2017).

The chart above uses the British Menopause Society and Women's Health Concern figures, based on NICE NG23 (2015) data: per 1,000 women aged 50 to 59 over 5 years, about 23 would get breast cancer anyway; combined HRT adds about 4, and estrogen-only HRT means about 4 fewer. BMS notes these figures are under statistical review since NICE updated NG23 in November 2024 (WHC infographic).

• Womb (endometrial) cancer: raised with estrogen alone if you have a uterus. A progestogen in the right dose protects against it. Any bleeding after menopause needs checking, on or off HRT. See bleeding after menopause.
• Vaginal estrogen: low-dose vaginal tablets and creams act mainly where they are applied, and do not appear to increase breast cancer risk (MHRA, 2019). See vaginal estrogen.
• If you have had breast cancer: systemic HRT is usually not recommended. Non-hormonal options exist, and any vaginal estrogen should be agreed with your oncologist. See non-hormonal treatments.

Breast cancer risk is shaped by many things besides HRT. In the BMS and Women's Health Concern figures for women aged 50 to 59 over 5 years, per 1,000 women: two or more alcohol units a day adds about 5, current smoking about 3, and a BMI of 30 or more about 24, while 2.5 hours a week of moderate exercise means about 7 fewer. Combined HRT adds about 4. The chart above lets you compare.

Things that actually lower your risk, or catch problems early:

• Keep up with breast checks and mammograms. A bilateral mammogram costs ₱1,500 per exam (PGH), and ₱2,000 to ₱3,500 per exam (Hi-Precision, Healthway) at private labs. Prices checked October 2026. Our screening planner shows what to schedule.
• Ask your doctor about micronized progesterone or dydrogesterone as your progestogen. A large French observational study (E3N) found less breast cancer risk with these than with other progestogens, but it was not a randomised trial (Fournier et al., 2008).
• Review HRT with your doctor once a year. Stopping or continuing is a choice you can revisit.

See a doctor soon for a new breast lump, skin dimpling, nipple discharge or a change in breast shape, whether or not you take HRT.