Once seen as a health buffer to reduce the impact of dwindling estrogen at menopause, hormone replacement therapy (HRT) has fallen out of favor in recent years. The catalyst was a report by the Women’s Health Initiative in 2002, which linked HRT to breast cancer for women who took both estrogen and progestin – the latter being a synthetic form of progesterone.
Studies are back and forth on the issue, and with plenty of claims and rebuttals. The Women’s Health Initiative has performed several follow-up studies linking HRT to breast cancer and several further health concerns, including heart disease and stroke. Others refute the findings, including an analysis done by South African researchers last year, who claim the data is unconvincing.
So the million dollar question: does HRT lead to breast cancer? The answer: maybe. You’ll find two camps here, but it can’t hurt to lean towards caution with hormone replacement therapy if you’re living with symptoms of menopause. You can also try natural remedies to HRT or even libido supplements with black cohosh to reduce symptoms without the can of worms called HRT
Two Kinds of HRT
As the name implies, hormone replacement therapy is designed to cushion the impact of lower estrogen and progesterone around menopause.
Symptoms of menopause, including hot flashes, dryness, loss of tissue, reduced libido and bone thinning occur because the ovaries produce less of these hormones on this biological milestone – leading some doctors and patients to consider HRT, which is available in two forms.
Estrogen Only Therapy – Available as a daily pill, patch or cream.
Estrogen/Progestin Therapy – Also called ‘combination HRT’, this combines estrogen with progesterone. This form of HRT can be taken as a continuous dose or sequentially, so patients receive different amounts of each hormone on specific days to mimic the natural menstrual cycle.
The consensus is that most women who’ve undergone hysterectomy (removal of the uterus) can generally take estrogen-only HRT. But women who still have their uterus need combination HRT because estrogen without progesterone increases risk of endometrial cancer – and it’s combination HRT that appears to have the strongest link to breast cancer.
No Smoking Gun – But Lots of Smoke
The subject of ongoing research, three large studies – the Collaborative Analysis, Women’s Health Initiative (2002) and Million Women Study – have explored the link at various times in the past decade and it comes down to this:
Combination HRT might increase risk of breast cancer, but more studies are needed.
The Women’s Health Initiative also claims that combination HRT raises the chance that breast cancer will be discovered in more advanced stages, because the treatment increases breast tissue density, which makes screening more difficult.
The link is further strengthened by a 2004 study which found that breast cancer survivors – who are more likely to experience menopause symptoms after treatment of the disease – were at higher risk of new or recurrent breast cancer when using HRT.
At present, the Women’s Health Initiative has done two randomized, placebo-controlled studies on HRT use among healthy women. The first looked at estrogen therapy in post-menopausal women who’d had a hysterectomy.
Five thousand women in this group took estrogen daily for six years. Researchers followed them several years after the study ended to look for further effects and compared them to a placebo group of more then 5000 women.
The second, and most famous of the two studies, looked at combined HRT in post-menopausal women who still had their uterus. More than 8500 women in this group took an estrogen/progestin product, to whom researchers compared with women taking a placebo
The results – women who took combination HRT had higher risk of breast cancer that those who did not take hormones. Or from another perspective, if 10,000 women took combined HRT for a year, you’d see eight new cases of breast cancer. The longer it’s used, the higher the risk.
Note that hormone replacement therapy – both estrogen only and combination HRT – are linked to further health risks, including endometrial cancer, colorectal cancer, ovarian cancer, stroke and heart disease. That’s another discussion in itself, but it’s something you’ll want to take up with your doctor should you pursue HRT for menopause symptoms.
HRT: Breast Cancer and Other Concerns
The decision to do hormone replacement therapy is unique to each woman. There’s no question that it can reduce symptoms of menopause. The real question is how much risk you’re willing to take. You’ve got company if you’re nervous about the risks of HRT, and while the treatment is probably safe for most women with no specific health concerns, there’s no harm in not doing it if you feel so compelled.
Don’t forget to look for natural alternatives to HRT either. Many women find that products with red clover and black cohosh can cushion the blow while the change takes place. Both ingredients can be easily purchased in many health stores, or you can opt for a female libido supplement like Provestra.
Your doctor will review your medical history and health considerations should you decide to go ahead with HRT. He or she will review baseline risk for breast, ovarian, colorectal and other kinds of cancer, along with your risk of heart disease, stroke and the effects of HRT on the brain.
Resist the urge to take estrogen therapy to help your brain during and after menopause, by the way. A 2013 study found synthetic estrogen did not help menopausal women with mental and cognitive function before, during or after the event.
Assuming you’ve jumped these hurdles, you’re convinced that HRT can help and your doctor has given you the go-ahead, you can manage your risks with the following guidelines:
Take a Low Dose – Your doctor will probably recommend the lowest dose required to reduce your menopause symptoms and for the shortest time possible.
Have Your Doctor Look For Cancer – You’ll want your doctor to look for signs of cancer each year too.
Report Any Vaginal Bleeding After Menopause – Do this immediately, because it’s a sign of endometrial cancer.
Check in with the American Cancer Society’s guidelines for cancer early detection to learn more about how to look for signs of cancer.
Remember, menopause is temporary and so are most of its symptoms. Hot flashes tend to fade with time, as do night sweats, and that’s all the more reason to do HRT for the shortest time possible, or better yet, skip it completely. The storm will subside – think of it as turbulence on the journey to the next phase of your body’s development. Proceed carefully if you do it with HRT. Don’t do it if you’ve had breast cancer in the past, or simply skip HRT in favor of safer, sometimes natural alternatives as the changes take place.