What this episode is about
Dr. Hardwick Smith walks us through what the research actually says about hormones and breast cancer recurrence, why the science has been misread and misrepresented for decades, and what women on the other side of a diagnosis are actually allowed to ask for, and receive.
Key takeaways
- Dr. Hardwick Smith says in the Women's Health Initiative, the women who took estrogen alone had a reduced incidence of breast cancer. She says the progestin Provera was the culprit.
- Dr. Hardwick Smith says that in a 2022 review of 25 studies, 24 showed no increase in breast cancer recurrence for women who took hormones.
- Dr. Hardwick Smith says there is zero argument against vaginal estrogen, even for a woman taking an aromatase inhibitor.
Moments from this episode
Word for word from the recording. Tap a time to hear it.
Experts help you decide
“We make our own decisions. We certainly seek out experts to help us make those decisions, but those experts are there to help us, your attorney, your accountant, not to tell us, you must do this.”
The person who decides is you
“So, reclaiming the right to have a collaborative relationship with your physician and to ultimately make the decision yourself. The person who decides is you, in my opinion.”
“For years, women were told that hormones cause breast cancer. And women who survived breast cancer were often told that hormone therapy was simply not an option. End of discussion.”
Gabriella Espinosaat 1:12
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Show notes
Hormone therapy after breast cancer is one of the most nuanced and emotionally charged conversations in women’s health.
For decades, many women have been told the answer is simply: no.
No discussion. No nuance. No consideration of quality of life, sexual health, bone health, brain health, or the individual woman sitting in the exam room.
But what does the research actually say?
In this episode of Pleasure in the Pause, I welcome back Dr. Susan Hardwick-Smith, board-certified gynecologist and certified menopause practitioner, for a grounded, evidence-informed conversation about hormone therapy after breast cancer.
Read the full show notesShow less
This is not a conversation about ignoring risk.
It is a conversation about understanding risk clearly, asking better questions, and making informed decisions in partnership with your physician.
Are you ready to awaken your sensuality and feel more empowered in your body? Access the FREE Pleasure Upgrade Bundle at pleasureinthepause.com/gift.
About our guest: Dr. Susan Hardwick-Smith is a Board-Certified Gynecologist and certified menopause practitioner specializing in women's midlife wellness, hormone optimization and sexual wellness. She is the founder of Complete Midlife Wellness Center in Houston, TX, and the best-selling author of "Sexually Woke- Awaken the Secrets to Your Best Sex Life in Midlife and Beyond." She also hosts the popular podcast "Empowering Midlife Wellness." Dr. Susan is the recipient of the Texas Super Doctor award over a dozen times, as well a multiple time recipient of H-Texas magazine's Top Doctor and Top Doctor for Women awards. She also has been chosen as one of Houston's "3 best rated" gynecologists several consecutive years. Dr. Susan is also an ICF certified life and leadership coach, multiple time marathoner and Ironman triathlete, and mother of 3 teenagers.
Highlights from our discussion include:
• What the Women’s Health Initiative actually found , and why the headlines created so much confusion • Why breast cancer type matters when discussing hormones • What the research shows about hormone therapy and breast cancer recurrence • Why some women on aromatase inhibitors may still be able to discuss options like progesterone, testosterone, and vaginal estrogen with their doctor • How to prepare for a more informed conversation with your physician • Why collaborative decision-making matters in women’s healthcare • The importance of considering quality of life, sexual health, bones, heart, and brain health , not just risk
My hope is that this episode helps you feel more informed, more empowered, and more confident asking questions about your own body and care.
Resources:
Dr. Susan Hardwick Smith: drsusan.com
Instagram: instagram.com/drsusanofficial
Hormone Replacement Therapy After Breast Cancer: It Is Time Avrum Z. Bluming, MD LINK - bit.ly/4st0uji Menopausal Hormone Therapy for Breast Cancer Patients: What Is the Current Evidence? LINK - bit.ly/41leKyt
Menopause Society consensus paper (January 2026): imsociety.org
American Urological Association Guidelines on Genitourinary Syndrome of Menopause 2025: auanet.org
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The information shared on Pleasure in the Pause is for educational and informational purposes only and is not intended as medical advice. Always consult your healthcare provider before making any decisions about your health or treatment. The views expressed by guests are their own and do not necessarily reflect the views of the host or Pleasure in the Pause.
About the guest
Dr. Susan Hardwick-SmithBoard-Certified Gynecologist and certified menopause practitioner specializing in women's midlife wellness, hormone optimization and sexual wellness2 episodes with Dr. Susan Hardwick-Smith on Pleasure in the Pause.See all their episodes
