Newsletter September 2026: The Truth About Perimenopause After Cancer
Dr. Tapp's Thought's
If you have followed my gardening stories this summer, you know that my vegetable garden did not begin auspiciously.
My seedlings were a disaster, growth was slow, and I wasn’t entirely sure what would survive…if anything.
Patience has paid off.
We have eaten the most delicious lettuce, dug up more potatoes than expected, watched the tomatoes begin to ripen and harvested more cucumbers and celery than I can count. I am most excited about my growing watermelons. Apparently, the garden had plans that it neglected to share with me.
The conversation around hormone replacement therapy (HRT), also known as menopause hormone therapy (MHT), has followed a somewhat similar path.
After years of hesitation and misinformation, HRT is finally receiving its well-deserved attention, so much so that backorders of some products are becoming a problem. I am so sorry if you’ve experienced this yourself!
Yet women with a history of cancer can feel left out of this conversation. Many have been told that because they have had cancer, HRT will never be an option. I want you to know that this is not always true.
As someone trained in both naturopathic cancer care and HRT/MHT, I understand that these decisions require knowledge of both worlds. September is Ovarian Cancer Awareness Month and Perimenopause Awareness Month, so let’s talk about HRT after ovarian cancer.
Some ovarian cancers may respond to hormones, while others do not appear to be hormone-sensitive. A history of ovarian cancer does not, by itself, make HRT unsafe.
Current research and British Gynecological Cancer Society guidelines suggest that systemic HRT may be considered following high-grade serous, mucinous, certain borderline and some clear-cell ovarian cancers.
It is generally not recommended following potentially hormone-sensitive ovarian cancers, including low-grade serous, endometrioid, granulosa cell and Sertoli-Leydig cell tumours. This is why the pathology report matters. The question is not simply, “Have you had ovarian cancer?” It is, “What exact type of ovarian cancer did you have?”
In one randomized trial, 150 women with ovarian cancer received HRT or no HRT. After a median follow-up of 19 years, both overall survival and progression-free survival were better among those assigned to HRT. HRT was used for an average of 1.14 years in the study, and on average, these women lived 2.9 years longer.
Another randomized study involving 130 ovarian cancer survivors found that estrogen therapy did not negatively affect disease-free interval or overall survival.
The evidence is not perfect, but it is reassuring enough that HRT should not be automatically dismissed for every ovarian cancer survivor. When both ovaries are removed, which is often the case with ovarian cancer survivors, estrogen, progesterone and testosterone levels fall abruptly. Hot flashes, insomnia, anxiety, brain fog, vaginal dryness, painful intercourse and changes in libido can appear almost overnight. Premature estrogen loss can also affect bone and cardiovascular health.
These symptoms should not be accepted as the price a woman must pay for surviving cancer.
HRT will not be appropriate for everyone, but menopause symptoms still deserve to be assessed and treated. Cancer survivorship is about more than preventing recurrence. It is also about protecting your sleep, bones, heart, relationships, sexual health and quality of life.
Like my garden, the evidence around HRT after ovarian cancer may be more fruitful than it first appears. If you have survived ovarian cancer, you deserve more than an automatic no. You deserve an individualized conversation based on the evidence, your pathology and the whole person sitting in front of your healthcare provider
Clinic News
The Iron Deficiency Epidemic Webinar Replay
The truth is, iron deficiency is one of the most overlooked causes or contributors of fatigue, brain fog, hair loss, restless legs, poor exercise tolerance, dizziness, headaches, ADHD, anxiety, shortness of breath, and feeling like you're just not yourself. Even more frustrating? Many people are told their iron is "fine" when it may be far from optimal.
In this replay, Dr. Tapp Leonard will dive into how to know if your iron levels are impacting your health, which tests you actually need to confirm iron deficiency, pros and cons of method to replete your iron levels (food, supplements, infusions), and common mistakes that prevent iron from improving.
Passcode: 2^?h0*pS
As we move from summer into the cooler, drier air of Fall, your skin barrier is one of the first places to feel the change.
Research shows that dropping humidity reduces hydration in the skin's outer layer and weakens protective lipids, which is why many notice more dryness, sensitivity, and flares this time of year.
For eczema-prone skin specifically, this matters even more: atopic dermatitis, aka eczema, already involves a compromised skin barrier and an immune system on higher alert. The added stress of seasonal dryness can tip things toward a flare and more reactive skin.
From transitioning your skin care to supporting your skin internally, here are 5 simple things you can do to support your skin this fall.
Happy Skin Starts Here
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