The Truth About Estrogen: What Survivors, Previvors and High-Risk Women Need To Know

For decades, survivors and high-risk women have heard one sentence that shapes their entire experience of menopause and long-term health: You cannot take estrogen. It is delivered with confidence, finality, and absolutely no room for discussion. Yet for many women, that warning is not rooted in evidence. It is rooted in outdated training, fear of liability, or a lack of comfort prescribing hormones for complex cases.

The truth is far more nuanced. And for many survivors, hearing the real story can be life changing.

Dr. Haver’s recent conversation with Dr. Corinne Menn, an OB GYN, certified menopause practitioner, breast cancer expert, medical advisor for Alloy, and twenty four year survivor of breast cancer and premature menopause, reframed everything we think we know about estrogen safety. She is a woman who has lived the full arc of cancer diagnosis, treatment, surgically induced menopause, recovery, recurrence fear, and rebuilding her life piece by piece. She is also a physician who treats survivors and high-risk women every day. She has seen the suffering that goes unnoticed and the symptoms that are dismissed. She has witnessed how many women are left without guidance when cancer treatment triggers menopause long before nature intended.

Here are the five lessons from our conversation that every survivor, previvor, and high-risk woman deserves to know.

1. Treatment ends, but survivorship and menopause continue

When Dr. Menn was diagnosed with breast cancer at twenty eight, she was in the middle of her OB/GYN residency and was working one hundred hour weeks. Her mother had just died of ovarian cancer. She was grieving and exhausted. Then she was thrown into surgery, chemotherapy, and sudden, chemically induced menopause.

Her hot flashes were relentless. Her night sweats left her drenched. She had panic attacks, insomnia, brain fog, depression, and profound sexual pain. Yet none of these symptoms were treated as legitimate medical concerns. They were viewed as an unfortunate side note to cancer treatment. She was told that treatment was over and that she should feel grateful.

But this is exactly when the suffering often begins.

Cancer survivorship and menopause care cannot be separated. Not when so many women are forced into menopause as a direct consequence of treatment. Not when symptoms can persist for years or decades. And not when the long-term effects of hormone deprivation can affect heart health, bone health, cognition, sexual function, and mental health.

The moment treatment ends is the moment survivorship begins, and menopause care must be part of that reality.

2. Doctors warn about chemo side effects, but not treatment-induced menopause

During chemotherapy, Dr. Menn was pre-medicated for nearly every expected side effect. She received steroids and anti-nausea medications. She was given panic medications during infusions and injections to prevent immune suppression. Every anticipated reaction was addressed.

Except menopause.

No one told her that her ovaries were likely to fail. No one explained the symptoms that were coming or how severe they could be. No one discussed options for ovarian protection. No one mentioned genitourinary syndrome of menopause. No one explained that sexual pain, bladder urgency, and the loss of orgasm were common and treatable. No one warned her about the emotional and psychological fallout of losing estrogen so abruptly.

Her medical chart even recorded that she was terrified of premature menopause. The treatment plan written beneath that note consisted of a single prescription for Ambien.

That was it.

This is not an isolated oversight. It is the current reality for millions of women. Cancer teams are prepared to manage the side effects of treatment, but far too often they do not prepare women for the lifelong consequences of treatment-induced menopause. Survivors are left to figure it out on their own.

3. Many women are told they cannot take estrogen even when it is not medically forbidden

Out of all the insights Dr. Menn shared, this may be the most important: there are very few absolute medical contraindications to estrogen. When a doctor says that a woman cannot take estrogen, it often means that the doctor does not feel adequately trained or confident enough to prescribe it safely. It does not mean the patient is medically prohibited from using it.

This single insight has the power to change women’s lives.

A family history of breast cancer is not a contraindication. Dense breasts are not a contraindication. Migraines with aura, endometriosis, fibroids, Factor V Leiden, autoimmune disease, and many other conditions are not automatic reasons to deny hormone therapy. Yet countless women are told no for reasons unrelated to actual evidence.

The problem is systemic. Menopause medicine has evolved, but most clinicians graduated long before modern research existed. Many were trained during the height of fear surrounding hormone therapy. Others are concerned about litigation and prefer to say no rather than learn the nuance. Still others simply do not know how to treat complex patients.

The result is confusion, fear, and suffering for women who deserve individualized guidance, not blanket warnings rooted in outdated information.

4. Local vaginal estrogen is safe for breast cancer survivors and dramatically improves quality of life

This is one of the most misunderstood areas of menopause care. Dr. Menn regularly sees women who cannot have penetrative sex, cannot tolerate a pelvic exam, have recurring UTIs, or struggle to sleep because of constant bladder urgency. Many have been suffering for years. Almost all were told they cannot use vaginal estrogen. Some were even told to use coconut oil instead.

The reality is clear. Local vaginal estrogen does not raise systemic estrogen levels. It is considered safe for breast cancer survivors and is endorsed by major oncology and urology societies. It restores tissue health, improves lubrication, reduces urinary symptoms, and allows women to have comfortable sex again. It offers dignity, function, and quality of life.

Denying a survivor access to local estrogen is not cautious. It is harmful.

5. Early and premature menopause increase health risks and require hormone informed care

One in eight women experiences menopause before the natural age, either from surgery, chemotherapy, or ovarian insufficiency. Losing ovarian function early dramatically increases the risk of cardiovascular disease, osteoporosis, cognitive decline, depression, anxiety, and metabolic disease.

Yet many women who undergo oophorectomy (removal of the ovaries) are not given a hormone replacement plan afterward. Some are never even told they will enter menopause immediately after surgery. Dr. Menn calls this a form of medical malpractice, not because removing the ovaries is wrong but because abandoning women to cope with the aftermath alone is unacceptable.

Removing ovaries lowers ovarian cancer risk. Replacing hormones does not erase that benefit. And for BRCA carriers who have already had mastectomies, withholding hormones often makes no biological sense.

Women deserve better. They deserve counseling rooted in evidence, not in fear.

The message every survivor, previvor and high-risk woman needs to hear

If you have ever been told that you cannot take estrogen, you deserve a second opinion. You deserve clear information about your actual risks. You deserve a physician who understands survivorship, menopause, genetics, and hormone therapy. You deserve care that considers both quality of life and long-term health.

If you love a survivor.
If you are a previvor.
If you carry a BRCA mutation.
If you are terrified of recurrence.
If your symptoms were dismissed.
If you were told to be grateful and endure.

You deserve more than fear. You deserve evidence-based, compassionate menopause care.

The old rules no longer apply. Women are reclaiming their health, their comfort, and their right to informed decisions. And the conversation is only just beginning.

Watch the full conversation with Dr. Corinne Menn on YouTube, or listen to the episode on unPAUSED wherever you get your podcasts.