A family history of breast cancer does not automatically mean you can never take HRT — but it does mean the conversation needs to be more careful, more individual, and ideally involving more than one doctor.

Here is what the evidence actually shows. A first-degree relative (mother or sister) with breast cancer is a recognised risk factor for breast cancer. HRT — particularly combined oestrogen and progesterone — does carry a small increase in breast cancer risk with longer duration of use. But “small” and “absolute” are important words: for combined HRT, the absolute risk increase is estimated at around 4–8 extra cases per 1,000 women over 5 years of use, compared to not using HRT. This is smaller than the risk increase associated with being obese, or drinking two units of alcohol per day.

For you specifically: a family history adds to your baseline risk, but your total picture — your personal health history, your symptom burden, your other risk factors, and whether BRCA testing is relevant — needs to be assessed individually. Your gynaecologist may refer you for genetic counselling if your mother’s cancer was early-onset or if other family members have had breast or ovarian cancer.

Vaginal oestrogen (local, low-dose, applied directly to vaginal tissue) is generally considered much lower risk than systemic HRT because systemic absorption is minimal. This is worth discussing even if systemic HRT feels too uncertain for now.

The decision involves weighing your individual risk profile against your quality of life with untreated perimenopause symptoms. Please make it with accurate, up-to-date information and proper medical guidance — not based on fear or a blanket assumption.