Risks and Benefits of Hormone Replacement Therapies

Hormone Replacement Therapy and Cancer Risk

A major issue surrounding hormone replacement therapy (HRT) and estrogen replacement therapy (ERT) is the influence of estrogen on breast cancer. Researchers believe that the longer your lifetime exposure to naturally occurring estrogen, the greater your risk of breast cancer. It has not been proven, however, that estrogen administered at menopause has the same effect. There is disagreement on the many trials conducted to date because of wide variations in the populations studied and the doses, timing, and types of estrogen used. A recent analysis of previous studies suggests that low-dose estrogen taken on a short-term basis (10 years or less) does not pose increased risk of breast cancer.

Long-term use (more than 10 years) at a high dose may significantly increase the risk. By how much is still a matter of heated debate. At the very most, researchers think long-term use could possibly increase the risk of getting breast cancer by 30 percent. This means that incidence would rise from 10 women per 10,000 each year to 13 women per 10,000 each year. To reach any consensus, however, more women need to be monitored for an extended period of time. The fear of cancer is one of the most common reasons that women are unwilling to use HRT. Interestingly, actual death rates for breast cancer have not risen at all. This may be because estrogen users have more frequent medical visits and obtain more preventive care including yearly mammograms.

While no one can determine who will eventually develop breast cancer, there are certain risk factors you should be aware of when considering HRT. A family history of breast cancer (sister or mother) is probably the most important risk factor of all. You may also be at an increased risk if: you menstruated before age 12; delayed motherhood until later in life; or have a late menopause (after age 50). Also, the older you are, the higher the risk. Most doctors believe that if you are not in a high-risk category for breast or endometrial cancer, the benefits of HRT far outweigh the risks. However, for some women, the side effects of therapy make it impossible to use. This is a personal decision to be made by each woman with help from her doctor.

Cautions To Estrogen Use

  • Stroke
  • Recent heart attack
  • Breast cancer (current or family history)
  • Uterine cancer
  • Acute liver disease
  • Gall bladder disease
  • Pancreatic disease
  • Recent blood clot
  • Undiagnosed vaginal bleeding
  • Cigarette smoking
  • Hypertension
  • Benign breast disease
  • Benign uterine disease
  • Endometriosis
  • Pancreatitis
  • Epilepsy
  • Migraine headaches
  • Nausea
  • Headaches
  • Breakthrough bleeding
  • Depression
  • Fluid retention