October hands us two big dates this year.

Breast Cancer Awareness Month runs all month long. And on October 18, World Menopause Day, the International Menopause Society has chosen its 2026 theme: Chronic Pain at Midlife.

Most people will treat those as two separate conversations. I don’t. Because for more than 2 decades, one of them has been feeding the other.

Women were told hormones cause breast cancer, so they went without. Many of them are sitting in your exam room right now with aching joints and stiff mornings. They’ve been told it’s just aging.

It is not just aging. And the fear that kept them off hormones does not hold up.

Where the fear came from

In 2002, the Women’s Health Initiative stopped its estrogen-plus-progestin arm early, and headlines told the world hormones cause breast cancer. Providers stopped prescribing. Women threw their prescriptions away.

But look at what was actually tested. Oral conjugated equine estrogen, made from pregnant mares’ urine. Plus medroxyprogesterone acetate, a synthetic progestin. Given to women whose average age was 63.

Wrong hormones. Wrong route. Wrong population.

In November 2025, the FDA finally began removing the broad boxed warnings from menopausal hormone therapy, including the breast cancer language. TWENTY-THREE YEARS. Twenty-three years of hot flashes, sleepless nights, bone loss, and pain, while that warning sat on the box.

It makes me so angry! Okay. Let me get off my soapbox and give you the evidence, because that’s what you need when a patient pushes back.

Number one: estrogen

The WHI had a second arm that got a fraction of the press. Women who’d had a hysterectomy took estrogen alone, with no progestin. After more than 20 years of follow-up, published in JAMA in 2020, that group had 22% fewer breast cancers than placebo. And 40% fewer deaths from breast cancer.

Hear me say that. In the largest randomized trial we have, estrogen alone lowered breast cancer risk. 

The arm that raised risk was the arm that added the synthetic progestin. That’s where the real story lives.

Number two: progesterone is not a progestin

This is the distinction I’ve been defending for more than three decades.

Think of hormones like a lock and a key. Bioidentical progesterone is the exact key your body makes. It fits the progesterone receptor the way nature designed it to. Medroxyprogesterone acetate is a different molecule. It sort of fits that lock, and it jiggles a few other locks while it’s at it.

Different molecules. Different outcomes.

The French E3N study followed more than 80,000 postmenopausal women. Estrogen combined with progesterone showed no increase in breast cancer risk, a relative risk of 1.00. Estrogen combined with synthetic progestins? A relative risk of 1.69. A Mayo Clinic meta-analysis later pooled the available studies and found progesterone carried about a third less breast cancer risk than synthetic progestins.

I’ve been on bioidentical hormones for 32 years. Progesterone is not the villain in this story. It never was.

Number three: testosterone

Researchers at the NIH have described how androgens help protect breast cells from excessive estrogen stimulation. And the clinical data point the same direction.

Dr. Rebecca Glaser followed 1,267 women using subcutaneous testosterone pellets for 10 years. They developed 11 invasive breast cancers when 18 were expected for their ages, a significantly lower rate than national SEER data. An earlier Australian study of 508 women adding testosterone to their usual hormone therapy found breast cancer rates close to those of women who never used hormones at all.

Now. However.

These are observational studies. Nobody has run the large randomized trial on testosterone and breast cancer in women. So say what the data show and no more. “Testosterone has not been shown to raise breast cancer risk, and the research points toward protection” is a sentence you can defend anywhere. I want you able to defend every word you say in that exam room. That protects her. And it protects your license.

October 18: the pain nobody is treating

The International Menopause Society chose chronic pain because women’s pain at midlife so often gets underestimated and overlooked. Or handed an anti-inflammatory and a pat on the shoulder.

A 2024 review in Climacteric, the IMS’s own journal, gave this a name: the musculoskeletal syndrome of menopause. More than 70% of women experience musculoskeletal symptoms through the transition, and 25% are disabled by them. Joint pain. Loss of muscle. Loss of bone. Progression of osteoarthritis. The authors tie it directly to falling estrogen.

So the hormones matter here too.

Start with estrogen. In that same WHI estrogen-alone trial, women on estrogen had less frequent and less severe joint pain than women on placebo after one year, and the difference held through year three. Modest, the researchers said. But sustained.

Then testosterone. In our training, aches and joint pain sit right on the symptom list for low androgens in women, alongside the fatigue that sleep doesn’t fix. And a small Dartmouth pilot study gave transdermal testosterone gel to 12 fibromyalgia patients for 28 days. Muscle pain, stiffness, and fatigue all decreased. Small and early. But it lines up with what providers see every week.

Now picture her. She’s in her fifties. Her knees hurt. Her shoulders hurt. She’s exhausted by two in the afternoon. And nobody has ever offered her hormones, because somebody told her about breast cancer in 2002.

What’s wrong with that picture?

Bottom line

The fear was built on the wrong molecules. The evidence on estrogen, bioidentical progesterone, and testosterone tells a very different story. And the cost of that fear shows up as pain your patients were told to live with.

What this means for you:

Number one. When a patient says “hormones cause breast cancer,” have your answer ready. Estrogen alone in the WHI meant 22% fewer breast cancers. Progesterone is not a progestin. Know the difference, and say it with confidence.

Number two. Ask about pain. Joint pain, muscle aches, morning stiffness. Put it on your intake form. Then run a comprehensive panel, including total and free testosterone with SHBG, not just an estradiol and a TSH.

Number three. Last month I told you about the FDA’s workshop on testosterone in menopausal women. The public comment docket, FDA-2026-N-5479, closes October 19, the day after World Menopause Day. If you haven’t shared your clinical experience yet, this is your week.

This is the work we do inside the BHRT Training Academy. The evidence. Comprehensive testing. Individualized protocols. And a mentor community behind you when a case gets complicated. Permission to prescribe is not mastery. Mastery is what lets you answer the breast cancer question calmly, and then help the woman in front of you who hurts.

She’s waiting for you. Let’s be ready for her.

Donna White is The Hormone Defender and founder and CEO of the BHRT Training Academy, that trains providers in comprehensive, evidence-based bioidentical hormone care.

Sources

  • International Menopause Society. World Menopause Day 2026: Chronic Pain at Midlife. https://www.imsociety.org/education/world-menopause-day-2026/
  • U.S. Food and Drug Administration. HHS Advances Women’s Health, Removes Misleading FDA Warnings on Hormone Replacement Therapy. November 10, 2025. https://www.fda.gov/news-events/press-announcements/hhs-advances-womens-health-removes-misleading-fda-warnings-hormone-replacement-therapy
  • Chlebowski RT, Anderson GL, Aragaki AK, et al. Association of Menopausal Hormone Therapy With Breast Cancer Incidence and Mortality During Long-term Follow-up of the Women’s Health Initiative Randomized Clinical Trials. JAMA. 2020;324(4):369-380. https://doi.org/10.1001/jama.2020.9482
  • Fournier A, Berrino F, Clavel-Chapelon F. Unequal risks for breast cancer associated with different hormone replacement therapies: results from the E3N cohort study. Breast Cancer Res Treat. 2008;107(1):103-111. https://doi.org/10.1007/s10549-007-9523-x
  • Asi N, Mohammed K, Haydour Q, et al. Progesterone vs. synthetic progestins and the risk of breast cancer: a systematic review and meta-analysis. Syst Rev. 2016;5(1):121. https://doi.org/10.1186/s13643-016-0294-5
  • Glaser RL, York AE, Dimitrakakis C. Incidence of invasive breast cancer in women treated with testosterone implants: a prospective 10-year cohort study. BMC Cancer. 2019;19(1):1271. https://doi.org/10.1186/s12885-019-6457-8
  • Dimitrakakis C, Jones RA, Liu A, Bondy CA. Breast cancer incidence in postmenopausal women using testosterone in addition to usual hormone therapy. Menopause. 2004;11(5):531-535. https://doi.org/10.1097/01.gme.0000119983.48235.d3
  • Wright VJ, Schwartzman JD, Itinoche R, Wittstein J. The musculoskeletal syndrome of menopause. Climacteric. 2024;27(5):466-472. https://doi.org/10.1080/13697137.2024.2380363
  • Chlebowski RT, Cirillo DJ, Eaton CB, et al. Estrogen alone and joint symptoms in the Women’s Health Initiative randomized trial. Menopause. 2013;20(6):600-608. https://doi.org/10.1097/GME.0b013e31828392c4 
  • White HD, Brown LAJ, Gyurik RJ, et al. Treatment of pain in fibromyalgia patients with testosterone gel: pharmacokinetics and clinical response. Int Immunopharmacol. 2015;27(2):249-256. https://doi.org/10.1016/j.intimp.2015.05.016
  • Federal Register: Testosterone Use in Menopausal Women; Public Workshop; Request for Comments (Docket FDA-2026-N-5479), August 18, 2026. https://www.federalregister.gov/documents/2026/08/18/2026-16829/testosterone-use-in-menopausal-women-public-workshop-request-for-comments
  • BHRT Training Academy, Hormones and HRT Prescribers Manual, Second Edition (2025): Testosterone and Women’s Health.