HRT with high lifetime breast cancer risk and osteoporosis

What a dilemma! Have you had the test for BRCA 1 & 2?

@gravity3 I tested negative for BRACA1 and 2. That made me feel better, but even then my risk is still considered "higher than average " by multiple risk calculation tools I found online. I found studies that show estradiol itself doesn't increase the risk, but the progesterone does. According to these studies, micronized progesterone is safer. I did find a provider online willing to give me estradiol and micronized progesterone and I did start treatment, but now I'm having second thoughts. I don't know what scares me more-the osteoporosis or breast cancer. I feel paralyzed.

@soggybones

I completely understand your paralysis. It can all be so intimidating. So much research,.other's experiences, doctor's advice, then your own values, fears and ideas about how you'd like to live. About osteoporosis. Can you tell us what your dexa scores are? Were you hoping that hrt/bhrt could tackle your bone loss effectively? Are you considering osteoporosis medication or are you looking at a number of life style adjustments like diet, supplements, type of exercise?

@soggybones
My mother and sister both had breast cancer in early 50's. Mother passed from BC due to lack of treatments available at that time. Sister is doing okay.
I am 59. I have dense breast, I was tested for BRACA 1 & 2 and was negative.
I have osteoporosis in my spine diagnosed in 2023. I am opposed to the osteo meds. I had hot flashes, poor sleep due to getting up through out the night, as well as vaginal atrophy.
I researched, reviews these forums as well as a few others and decide Bioidentical HRT was the route to try first. I started last March 2025. Found a integrative DR that listened to my concerns, that did an abundance of testing prior to starting any HRT.
I am using compound creams containing estradiol, estriol and progesterone. And am using the smallest amouts that have had a positive effect.
Am monitoring via bloodwork every 3 months along with regular mammograms etc. I know compounded creams are not FDA approved and some may state concerns, but I trust the pharmacy that does it, they've been around many years. They also did a compounded cream for a rare skin cancer for my husband many years ago, that resolved his skin issue. Compounding exists for a reason.
Compounded creams are so customizedable, which I needed because too much estradiol gave me a reaction.
Currently I've had no hot flashes since starting, I sleep through the night and vaginal atrophy has resolved. My recent blood test for my bone markers show stabilization of bone loss, my scans show BMD is improving along with my Trabecular Bone Score which has increased as well.
It was a hard decision to go this route given the risks, but i felt this was the least risky path.
I also read somewhere that if breast cancer were to occur it might be that was what was destined to occur and might not have anything to do with the HRT. That statement along with plenty of other info helped me think differently about it.

Have you considered Menostar?

I'm not familiar with Menostar. Is it safer than other estrogen patches? I've been given Estradiol patch from Grove pharmaceutical. It delivers .0375mg/day of estradiol. I also take 100mg micronized progesterone.

@oknowwhatpixie Your situation sounds remarkably similar to mine. I was also told I could get breast cancer regardless of doing hrt. That made me think I might as well try hrt and at least get a few quality of life years out of it. I was thinking of just doing it for 3 or 5 years then wean off of it. I would be thrilled if it increased my bone density, but even more thrilled if it increased my very low TBS score. I was told it wouldn't improve my TBS at all, but if it can buy me some more time before having to start other osteoporosis drugs then that would be a win. I get screened for breast cancer every 6 months-a 3D mammogram in the winter and an MRI every summer. My hope is that if I develop cancer it will be caught early. Hopefully I can avoid taking an aromatase inhibitor and take tamoxifen instead. It's not as effective as AI, but it's better than nothing. Fingers crossed!!

@gravity3 I have a T-score of -2.3 in my spine and T-score of -1.4 in my total hip and -1.2 in my femoral neck. My TBS is bad: 1.191. I would like to do an anabolic to get my TBS up a little (difficult to do). I was just hoping HRT could help with my awful menopause symptoms and at least halt the bone loss. I met with Dr.MCCormick and he suggested waiting a year to get another DEXA before starting an anabolic. He suggested HRT could be helpful if I'm comfortable with the risks. I'm meeting with an endocrinologist next month and I'll get her opinion on my plan. I was happy with my plan until I started hearing about breast cancer survivors and their struggles with osteoporosis. Some actually had to go on some very powerful antiabsorbatives and that really scares me. Most patients with osteonecrosis of the jaw are cancer patients. It's a horrible condition and I don't want it!

@soggybones
The good thing, spinal bone shows changes more quickly than hip/femor due to faster turnover. Bone markers or DEXA will give you feedback if things are headed in right direction.
I am planning to do BHRT for about 5 years, will reassess each year as I work with my doctor.
If I'm able to live a long life, I was struggling with how to use the osteo meds over a pssoble 15-20 year span. It just didn't make sense to me given all the possible side effects. I also suffer from migraines and know any new thing introduced into my system will be a trigger for me. I didn't want to deal with the osteo meds creating more migraine days for me.
Luckily I've not fractured to date and even with my lumbar spine tscore at 3.5, on a Hologic machine, my TBS still showed good architecture. That factored into my decision as well.

My TBS was 1.391 and almost a year later (after being on BHRT) it is 1.429, which is increasing in a positive direction.
Good luck on your journey.

@oknowwhatpixie If you have a uterus you have to take progesterone with the estradiol.