Medical Oncologist
Fertility and menopause
Pausing hormone therapy to try for a baby: what the evidence shows
Some young women with early hormone-positive breast cancer can take a supervised pause from hormone therapy to try for a baby. The POSITIVE study found most became pregnant, with similar short-term recurrence rates. This page explains the evidence, its limits and what a pause involves.
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Medically reviewed by Dr. Naresh GunduConsultant Medical Oncologist · MBBS, DNB (Internal Medicine), DM (Medical Oncology, AIIMS) · last reviewed September 2026, next review due September 2027
On this page
- Can you pause hormone therapy to try for a baby?
- Key points from the POSITIVE study
- The typical stages of a supervised pause, in general terms
- The vocabulary, in plain language
- What the evidence can and cannot tell you
- Who may be suitable for a supervised pause
- What to expect while hormone therapy is paused
- Alternatives to pausing hormone therapy
- Restarting hormone therapy after the pause
- Improving the chance of conceiving during a pause
- What people assume about pausing hormone therapy
- Common questions about pausing hormone therapy for pregnancy
The short answer
Can you pause hormone therapy to try for a baby?
For some young women with early, hormone receptor positive breast cancer, a planned and supervised pause in hormone therapy to try for a baby is now a recognised option. Hormone therapy, such as tamoxifen, or an aromatase inhibitor with ovarian suppression, is usually recommended for five to ten years, and pregnancy is not safe while taking it. For women who want children, waiting that long can mean fertility declines with age. The international POSITIVE study looked at this question. It enrolled women aged forty-two or younger with early hormone receptor positive breast cancer who had taken hormone therapy for between eighteen and thirty months. They paused treatment, waited about three months for the medicine to clear from the body, then tried to conceive for up to two years, before restarting hormone therapy. Most women in the study became pregnant, and many had healthy babies. Importantly, the rate of breast cancer returning during the follow-up reported so far was similar to that seen in comparable women who did not pause treatment. Longer follow-up is continuing. A pause is not right for everyone, and the decision should be made with your oncologist, considering your cancer stage, recurrence risk, age, fertility and personal priorities.
It must be supervised
Never stop hormone therapy on your own. Your oncologist will plan timing, monitoring and restarting.
Plan to restart
Women in the study restarted hormone therapy after pregnancy, delivery or breastfeeding, or after two years without pregnancy.
Consider fertility help early
A fertility specialist can assess egg reserve and discuss using frozen eggs or embryos.
This page gives general information only. It is not a recommendation for your individual treatment.The evidence
Key points from the POSITIVE study
The main research behind supervised pauses.
Who took part
Women aged forty-two or younger with early hormone-sensitive breast cancer.
When they paused
After eighteen to thirty months of hormone therapy.
Pregnancy results
Most women had at least one pregnancy, and many had live births.
Some used fertility treatment or frozen embryos.Cancer outcomes
Short-term recurrence rates were similar to a comparison group.
Still being studied
- Long-term recurrence
- Outcomes in higher-risk cancers
- Effects of breastfeeding on outcomes
How a pause works
The typical stages of a supervised pause, in general terms
Stage
What usually happens
Discussion and assessment
Review of cancer risk, fertility and wishes with your oncologist
Stopping hormone therapy
Medicine stopped under supervision, with a wash-out period of about three months for tamoxifen
Trying to conceive
Naturally or with fertility treatment, for up to about two years
Pregnancy and breastfeeding
Regular breast checks continue during this time
Restarting
Hormone therapy resumes to complete the recommended duration
Words you will hear
The vocabulary, in plain language
- Endocrine therapy
- Another name for hormone therapy for breast cancer.
- Tamoxifen
- A tablet that blocks oestrogen from reaching breast cancer cells.
- Aromatase inhibitor
- A tablet that lowers oestrogen, used with ovarian suppression in younger women.
- Wash-out period
- Time for a medicine to leave the body before trying to conceive.
- POSITIVE study
- An international trial of pausing hormone therapy for pregnancy.
- Treatment interruption
- A planned temporary stop in treatment.
Being straight with you
What the evidence can and cannot tell you
The POSITIVE study is reassuring, but it has limits you should understand.
Follow-up is still relatively short
Hormone-sensitive breast cancer can return many years later, so long-term results are still being gathered.
Mostly lower-risk cancers
Most participants had early-stage cancer. Evidence for women with higher-risk cancer is more limited.
Not every pregnancy succeeds
Some women did not become pregnant, and some needed fertility treatment.
Adherence matters
The benefit depends on restarting hormone therapy afterwards and completing treatment.
What this page cannot tell you
It cannot tell you whether a pause is safe for you. Your oncologist can assess your situation.
Suitability
Who may be suitable for a supervised pause
Oncologists consider several factors when discussing a pause.
Cancer stage and risk
Women with early-stage cancer and lower recurrence risk are generally better candidates.
Time on treatment
Most teams suggest completing at least eighteen months to two years of hormone therapy first.
Age and fertility
Age and egg reserve affect the chance of conceiving within the pause.
Other health factors
BRCA status, previous chemotherapy and general health are considered.
Your priorities
Your wish for children, and how you feel about the uncertainty, are central to the decision.
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During the pause
What to expect while hormone therapy is paused
A pause involves careful planning and follow-up.
Regular breast checks
Clinical examinations and imaging continue, adapted during pregnancy.
Fertility support
If pregnancy does not happen within several months, fertility assessment or treatment may be advised.
Report new symptoms
Tell your team about any new lump, bone pain or other concerning symptoms promptly.
Breastfeeding
Many women in the study breastfed. Your team will advise on timing of restarting treatment afterwards.
Emotional support
Worry about recurrence while off treatment is common. Counselling can help.
Other options
Alternatives to pausing hormone therapy
A pause is one of several options.
Completing hormone therapy first
Some women prefer to finish treatment before trying, accepting lower fertility with age.
Using frozen embryos with a surrogate
Where legally permitted, this can allow treatment to continue, though it has its own complexities.
Donor eggs or adoption
These are options when fertility has declined.
Afterwards
Restarting hormone therapy after the pause
Restarting hormone therapy is an essential part of a supervised pause, because the full course is what lowers the long-term risk of the cancer coming back.
When to restart
In the POSITIVE study, women were asked to restart after pregnancy and any breastfeeding, or if they had not become pregnant within about two years. Your oncologist will agree a specific plan with you.
Completing the full duration
The time already taken before the pause counts towards the total. The remaining years are completed after restarting, so the overall length of treatment stays as recommended.
Side effects on restarting
Hot flushes, joint aches and mood changes may return. Reporting them early allows your team to help, which makes it easier to keep taking treatment.
Contraception
Once hormone therapy restarts, reliable non-hormonal contraception is needed again, as tamoxifen and other hormone medicines can harm a developing baby.
Planning another pregnancy
If you hope for more than one child, discuss this early. Evidence about repeated pauses is limited, so decisions are individual.
Keeping follow-up going
Regular check-ups and mammograms continue throughout treatment and beyond.
Fertility
Improving the chance of conceiving during a pause
Because the pause has a time limit, some preparation helps.
Check fertility before stopping
Blood tests and scans can estimate egg reserve and guide whether early fertility help is wise.
Look after general health
Taking folic acid, keeping a healthy weight and stopping smoking all support conception and a healthy pregnancy.
Use frozen embryos if you have them
Embryos stored before treatment can shorten the time needed to conceive.
Commonly believed
What people assume about pausing hormone therapy
Stopping hormone therapy always makes cancer come back.
Short-term study results show similar recurrence rates with a supervised pause.
You can stop tablets on your own once you want a baby.
Any pause must be planned with your oncologist.
Once paused, hormone therapy is not needed again.
Restarting to complete treatment is part of the plan.
A pause suits every woman with hormone-positive cancer.
Suitability depends on risk, stage and individual factors.
Questions we are asked
Common questions about pausing hormone therapy for pregnancy
How long should I wait after stopping tamoxifen to try?
In the POSITIVE study, women waited about three months. Your oncologist will advise.
How long can the pause last?
The study allowed up to about two years to conceive, deliver and breastfeed.
Can I use IVF during the pause?
Yes, some women used fertility treatment or frozen embryos.
Can I breastfeed?
Many women did. Discuss timing of restarting treatment with your team.
Is a pause safe if I had chemotherapy?
Women who had chemotherapy took part; your oncologist will assess your risk.
What if I do not get pregnant?
Hormone therapy is usually restarted after the agreed time.
Does breastfeeding affect cancer risk?
Early data are reassuring; research continues.
Who decides?
You and your oncologist, together.
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Speak to a breast cancer specialist
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Sources
- New England Journal of Medicine — Interrupting endocrine therapy to attempt pregnancy after breast cancer (POSITIVE)
- European Society for Medical Oncology — Fertility preservation and post-treatment pregnancies clinical practice guideline
- National Cancer Institute — Hormone therapy for breast cancer
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.