Here’s what you need to know about menopausal hormone therapy and cancer risk 190



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Did you use Hormone replacement therapy in menopause?  Or did you choose not to actively?  This latest research will be of interest.  

The use of hormone replacement therapy (HRT) doubles the risk of breast cancer in menopausal Australian women, new research shows.

The study, published in the International Journal of Cancer, is consistent with international research and demonstrates that more judicious use of hormonal therapy could reduce rates of breast cancer.

But that doesn’t mean HRT has no place in alleviating moderate to severe symptoms of menopause such as hot flushes and vaginal dryness.

Hormones and breast cancer

Hormone levels have long been known to influence the development of breast cancer. The reduction in hormone levels that occurs during menopause is protective; while the risk of breast cancer increases with age, it increases less steeply after menopause.

Breast cancer is also more common in women with higher oestrogen levels and can be reduced with oestrogen-blocking medications such as tamoxifen.

Our joint Cancer Council NSW-Australian National University study compared the use of menopausal hormone therapy in 1,236 women with recently diagnosed invasive breast cancer and 862 women without cancer.

The findings are consistent with international evidence showing the risk of breast cancer increases the longer menopausal hormone therapy is used. The risks are greater with use of combined oestrogen-progestagen than with oestrogen-only therapy.

Current users of oestrogen-only therapy (who have been on HRT for around five years) have a 20% increase in the relative risk of developing breast cancer. Use for around ten years leads to a 30% increase in risk.

Corresponding figures for oestrogen-progestagen therapy are 60% (for five years of use) and 120% (for ten years).

The risks of breast cancer are increased, but to a lesser extent, with use for less than five years.

Breast cancer is relatively common. Among 1,000 women in their 50s, around ten would be expected to develop breast cancer over a five-year period. This would increase to 16 if those 1,000 women were taking oestogen-progestagen menopausal hormone therapy.

Among women with breast cancer, menopausal hormone therapy increases the risk of the cancer coming back.

The good news is that the elevated risks of menopausal therapy generally wear off within a few years of ceasing use.

Risks and benefits of HRT

Hormone therapy is an effective treatment for menopausal hot flushes, night sweats, vaginal dryness and thinning of the vaginal tissues. These symptoms can have major effects on quality of life for women.

It’s less clear if menopausal hormone therapy alleviates other menopausal symptoms that aren’t as clearly related to hormone levels, such as irritability, low mood and mood swings.

Menopausal hormone therapy has also been shown to reduce the risk of hip fractures and, potentially, bowel cancer.

But in terms of the balance of potentially life-threatening disease with use of menopausal therapy, the number of cases of breast cancer, stroke, ovarian cancer, blood clots and endometrial cancer caused by therapy exceeds the number of hip fractures and bowel cancers prevented.

So, the risks of these serious diseases outweigh the benefits. And the risks of combined oestrogen-progestagen therapy are greater than those of oestrogen-only.

These risks and benefits underpin the regulators’ recommendations for more than a decade in Australia, the United Kingdom and the United States that:

  • Menopausal hormone therapy should only be used for the short-term treatment of menopausal symptoms (such as hot flushes, night sweats, vaginal dryness)
  • Women considering using menopausal hormone therapy should be informed of its risks and benefits
  • Menopausal hormone therapy shouldn’t be used to prevent disease, or (in Europe and Australia) as first-line treatment for osteoporosis
  • HRT should be used for as short a period of time as possible and the need for continuing use should be reviewed every six to 12 months.

Preventing breast cancer

The publication of studies in 2002 and 2003 showing the risks of serious disease with HRT outweighed the benefits prompted immediate and rapid declines in use.

Menopausal hormone therapy use in Australia fell by 55% from 2001 to 2005. This was accompanied by a 9% fall in breast cancer diagnoses in women aged 50 and over, or around 800 fewer women diagnosed with invasive breast cancer annually. Similar reductions in use and subsequent breast cancer rates occurred in the United States.

The research published in the early 2000s attracted intense scrutiny. It was released at a time when menopausal therapy was widely used and promoted for its benefits, including the notion that it was “good” for women and would keep them healthier and somehow younger. Strong commercial interests were also at play.

Around 12% of women aged 40 to 65 years, or 500,000 women in Australia, are currently using menopausal hormone therapy. The majority have used it for more than five years.

Menopausal hormone therapy is estimated to cause at least 450 breast cancers each year in Australia – around 3.5% of all breast cancers.

More judicious and shorter-term use of menopausal hormone therapy could therefore further reduce the number of women suffering hormone therapy-related breast cancer, ovarian cancer and stroke.

What does this mean for you?

Menopausal hormone therapy should not be universal or automatic for women going through menopause. Nor should it be used to prevent diseases relating to ageing. This is a major change from what I was taught when I went to medical school in the early 1990s.

Although the news about the risks of hormone therapy isn’t great, it’s good that we’re aware of these risks and we no longer face the situation where many millions of women are using it, with little reliable evidence on its effects.

We now know that menopausal hormone therapy is a medication like any other, with risks and benefits and specific indications for use, including the treatment of moderate to severe menopausal symptoms, in informed women.

It’s not for doctors, researchers or other commentators to decide how to balance relief of menopausal symptoms against the risks of HRT for individual women considering use. That difficult task falls to women themselves, supported by the sum-total of the worldwide evidence and professionals and practice informed by that evidence.

When friends and family ask me about whether or not they should use menopausal hormone therapy, I advise that the current evidence is that they should avoid it if they can.

If they have menopausal symptoms that are sufficiently severe to warrant therapy, hormone therapy remains an important option. But it should be used for as short a time as possible, with regular (preferably six-monthly) reviews to check whether it’s still needed.

Did you use hormone therapy for menopause?  Do you worry about the decisions you made to do so?  

The Conversation——————————————–

By Emily Banks, Scientific Director of the 45 and Up Study, Sax Institute; Professor of Epidemiology and Public Health, Australian National University

This article was originally published on The Conversation. Read the original article.

The Conversation

The Conversation is an independent source of news and views, sourced from the academic and research community and delivered direct to the public. Their team of professional editors work with university, CSIRO and research institute experts to unlock their knowledge for use by the wider public. We republish The Conversation's content under Creative Commons License.

  1. about 15 years ago, the doctor wanted me to take hrt, l contacted my personal insurance company and asked them if l did what was the outcome on my policy, l was told if l took it my premiums would be going up, that was enough for me, and hey the symptoms were not as bad as the media made out to be, l tolerated it all for 10 years, and remained positive the whole time with my family support, especially hubbies

  2. I thought this theory about the alleged link between HRT and breast cancer had been definitely and conclusively debunked.

    4 REPLY
    • Apparently not. If you close your eyes you miss something. I think we all have to make our own decisions on what works for us.

    • BUT the only research quoted in the article was 2002 or there abouts. That was when the first “scare” started and doctors told everyone to get off HRT. After that more studies totally and thoroughly debunked the whole theory. I’ve seen a doctor on the TV saying the theory has been proven to be totally “wrong” was the word he used.

    • There have been articles regarding this issue in the news recently. Maybe wise to check with dr google.

  3. I use it, love it, will stay on it until I die! But it’s not for everyone, same as everything else in life!

    10 REPLY
    • Lol luv the comments girls – I Wacom HRT for 71/2 years been off it 8 months feeling great but still a few hot flushes so taking Femular herbal stuff working great.

    • I am off HRT, i have no symptoms of menopause what so ever , it helped me and I only took it for 12 months..I only take medication that I need, I think you can get over medicated but do what suits you and your body

    • I agree Libbi, I was on it for 12 months after I had a hysterectomy, however the side affects were very unpleasant so I decided to go off it. I have never had any of the nasties that go with menopause even though my doctor said I would, so I think we should go with our gut.

    • the feeling of ants under the skin was unbearable. HRT stopped that. been off it 10 years now. still get hot flushes at 66 but can put up with that.

    • I was on it for 15 years then after talking to my gyno I and only I , decided to stop …. Gyno said up to you … Well , I lasted for 7 months !!!! The pains in the body , the sweats, the sleepless nites , etc etc were just awful …I thought the pains were related to my cholesterol tabs … But no …. ! Now am back on my HRT the last 3 weeks , and slowly everything is disappearing …. I feel back to my normal self …!!! I am just great !!! 😃😃😃

    • Me too. Been on it 12 years now. Gone off it a couple times, not worth the lack of sleep, moodiness and energy crash. Will stay on it as log as possible.

      1 REPLY
      • I was on estrogen only for about 12 mths when I was diagnosed with breast cancer (hormone stimulated). I have now been off it for 4yrs and I will be going back on it asap. I have lost all drive (sexual and otherwise) and as time passes it all gets worse, including vaginal dryness (you have no idea how dry you can be until it occurs and at times walking is difficult without some ky or the likes).

        I understand the risks but I can understand the pain I am going through. I have tried treating this symptomatically with the assistance of my doc but it hasnt worked.

        next check up it will be my question…hrt all the way I say, I was happier and better with hrt

        1 REPLY
  4. After fighting dreadful symptoms for over 2 years I decided to take the HRT. For me my quality of life far weighed out the risks. I am still on HRT as I have tried to go off them several times. I would have gone insane or even worse could have killed someone, and I am not joking either. I guess it’s up to each individual to evaluate their need for HRT as not everyone’s suffers the same symptoms or the severity. My husband and family are probably extremely happy of my decision.

    3 REPLY
    • So glad to hear that someone else has the same views as me. I’m trying once again to go off the HRT but have probably picked the wrong time of year for this attempt.

    • Totally agree Denise and will probably stay on it till I die

    • Yes me too , so bad I could have taken my life HRT was offered and I took it , but sadly it wasn’t that good for me so my Doctor said we will try patches , and that was it , I was on a high doctor wanted see me the next week to see how I was going , I just said I am great don’t change any thing and he had another look at my paper and just said you should be on number 2 patches and a gave you number 4 you are not taking me off them , and from there my life got better and I had them for 13 years but then I had a clot in my lung and that was it finished but by then I could cope much better , yes I would have done it again , very healthy , take no pills at all and I am 76 in January hugs ooo

  5. I have seen so many “miracle” medications come on to the market over the years, and so many later found to be risky, my thoughts are , unless it is a matter of life or death, leave it.

  6. My wife tried the treatment but found the patches caused blistering and her periods started fortnightly. That was enough for her to give it up.

  7. It changed my quality of life dramatically. I couldn’t have gone through menopause without it. The benefits outweighed the risks.

  8. I am going through Menopause cold turkey. I have no problem with the physical symptoms it is the emotional symptoms that I struggle with. I view Menopause as a natural process and in my words it means that all ‘my lady bits ‘ are normal. Having a lot of friends and relations that have had to have hysterectomies I am grateful to have all ‘my lady bits’. Looking forward to being post menopausal.

    4 REPLY
  9. I used nothing as my Mum had breast cancer and I thought the risk was too great. I just sucked it up because I am Woman!

    5 REPLY
    • Sue Packer Funny. I have found talking to friends that every one is different. 2 of my friends have had no symptoms at all and others the symptoms have been dreadful. One of my friends has had electric shock treatment and is in my opinion now worse than she was before. I am somewhere in the middle. Everyday I fight the anxiety, mood swings. I am self aware and there are days when I give myself a good upper cut. I actively cultivate optimism and I avoid negative people. That is my way of coping.

    • it had the ants under the skin feeling. there is a name for it cant remember though. it was a terrible feeling.HRT stops that thank goodness was on it on and off for 10 years been off 5 years. now at 66.found patches the best. my mum was 92 when she died and still had problems.

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