Hormone replacement may be prescribed to reduce certain symptoms of natural or medically-induced menopause. For example, hormone replacement can decrease the frequency of hot flashes and help prevent thinning of the bones (osteoporosis).
There are two main types of hormone replacement: the use of estrogen (an approach called estrogen replacement therapy; abbrevoated ERT) and the use of a combination of estrogen and progestin (an approach called hormone replacement therapy; abbreviated HRT).
Because estrogen use by menopausal women raises the incidence of uterine cancer, the use of estrogen alone (i.e., ERT) is prescribed primarily for women who no longer have a uterus.
However, the Breast Cancer Demonstration Project found that women's risk of breast cancer went up by about 1% percent for every year that they took ERT. In addition, long-term use of ERT raises the risk of blood clots, strokes, and dementia.[1] On the other hand, the risk of cardiovascular disease (e.g., of the heart and blood vessels) and cerebrovascular disease (e.g., stroke) may occur in women who initiated ERT late in life.[1. 2]
The estrogen/progestin combination therapy (i.e., HRT) is usually reserved for women who still have a uterus, as the combination of hormones was shown to reduce the risk of uterine cancer compared to treatment with estrogen alone in post-menopausal women with a uterus.
On the other hand. the use of HRT has been shown to increase a woman's risk of breast cancer compared to that of post-menopausal women not taking the hormones. The Breast Cancer Demonstration Project found that for every year that women took HRT, their risk went up by about 8%. Furthermore, women receiving HRT have a higher risk of blood clots, heart disease, stroke.
The real risk with HRT is prolonged use -- the longer a woman uses HRT, the greater her risk of breast cancer. For example, if a woman takes HRT for 10 years, her risk of breast cancer will be 80% higher than if she had never used hormones. For both types of therapy, however, this increase in risk of breast cancer begins to drop after hormone use stops and eventually returns to that of someone who has never used hormones.
Therefore, women should not take ERT or HRT for prolonged periods of time. Women taking ERT or HRT should receive the lowest effective dose for the shortest length of time.[1] Furthermore, if ERT or HRT is to be used, therapy should be initiated shortly after menopausal symptoms begin, rather than later in life.
It is important to remember that many wonderful alternatives can help women alleviate undesired symptoms of menopause, without increasing their risk of breast cancer and perhaps without raising therir risk of heart disease or stroke. These alternatives include natural hormone replacements, lifestyle changes, and dietary modification.
REFERENCES
1. S. Boyles. WebMD Medical News. 02/13/06. Accessed at www.webmd.com.
2. J. Hsia. Archives of Internal Medicine. 02/13/06.
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