Menopause care has been ignored and brushed off for decades. Women were told to push through the exhaustion, the night sweats, the brain fog, the bone loss, as if it were just the price of getting older. So this new wave of attention feels overdue and honestly so hopeful. Women deserve relief and to feel great in their bodies again. But the message has narrowed, and menopause care is now often presented as hormone replacement therapy, full stop.

For the roughly 70-80 percent of breast cancer survivors whose cancers are hormone-driven, it is not that simple. We do not get to treat estrogen like a missing vitamin. For ER+ disease, estrogen signaling is literally a growth pathway the cancer can use. That biology is why standard guidance has generally been to avoid systemic menopausal hormone therapy after breast cancer, especially when the cancer was hormone receptor–positive. Reviews of the topic consistently note that guidelines typically consider systemic HRT contraindicated in breast cancer survivors, mainly because of recurrence concerns and limited reassuring randomized data.

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I am genuinely glad menopause care is finally getting real attention. Women deserve better than being told to just power through or accept feeling lousy as the price of aging. Still, somewhere along the way, the conversation started to feel a little one-note, as if there were one right answer and it always seemed to be hormones. It came up one night over dinner with friends. Smart, thoughtful women I trust. We were talking about perimenopause and how much better everyone felt after starting HRT. They were sleeping again. The hot flashes had eased. Energy was back. More than one person said, with real relief, that they finally felt like themselves.

At some point, someone turned to me and asked, “Are you on HRT?”

I said no.

I once had estrogen-receptor-positive breast cancer, the kind that grows when estrogen is around. For me, hormones are not just about comfort or quality of life. They come with the possibility of the cancer coming back. And if it comes back, it is metastatic, and at least right now, that means terminal. This is usually the moment in the evening when the table goes quiet and everyone suddenly remembers they need more wine. I felt that subtle shift in the room that happens every time the friend group is reminded that I am a cancer survivor and the unspoken understanding that my math is different. Same phase of life, different set of rules.

This does not mean I (and any of you in a similar situation)  are doomed to suffer. It just means our path looks different. Thankfully, science has begun to fill the gap for people who can’t or don’t want to use systemic hormones.

Veozah (fezolinetant) was the first non-hormonal FDA-approved treatment specifically for moderate to severe hot flashes and night sweats caused by menopause. It works by targeting a brain chemical pathway involved in body temperature regulation, blocking the neurokinin-3 receptor that becomes overactive when estrogen drops. In trials, Veozah reduced both the frequency and severity of hot flashes, helped with nighttime symptoms, and improved quality of life without introducing hormones back into the body. Some people notice benefits as early as a week after starting, and the effects have been sustained through longer follow-ups.

Lynkuet (elinzanetant) is the newest FDA-approved non-hormonal option. It works on two targets in the brain (the neurokinin-1 and neurokinin-3 receptors) which may help calm the internal thermostat that misfires in menopause. Because it acts on both pathways, it may not only reduce hot flashes and night sweats but also support better sleep for some people. In clinical trials, Lynkuet significantly lowered the frequency of moderate to severe vasomotor symptoms, with many participants seeing meaningful relief within weeks. 

These medications do not introduce estrogen into the body, which is why they are especially meaningful for people with hormone-sensitive breast cancer or others who need to avoid systemic hormones. They aren’t supplements or wellness trends. They are FDA-approved, evidence-based treatments that work without hormones, giving real symptom relief and helping many women reclaim normal daily life.

So when I hear another glowing story about HRT, I am genuinely happy for the women who can take it. I just no longer let it make me feel broken or behind. Menopause is finally being taken seriously. That is a win, but there is more than one way through it and we are each empowered to find our own way back to ourselves carefully and safely.

If you are trying to make sense of all of this, you do not have to do it alone. Outcomes4Me is a free app that gives you clear, evidence-based information about your cancer, your treatments, and the options available to you, including menopause care that actually takes your diagnosis into account. It helps you understand what applies to you, not just what is trending.