Hormone replacement therapy (HRT) can be a blessing or a curse. A common treatment for the symptoms of menopause, HRT can spare women many of the discomforts and health risks of aging. Administered properly, it can also offer protective benefits against uterine cancer and osteoporosis. But HRT may marginally increase a woman’s risk of breast cancer. So how can you find out if hormone therapy is right for you?
The first step is to take the right combination of hormones. “Some women have been improperly prescribed hormone replacement therapy—they have been given estrogen-only therapy when they have a uterus,” says Larry Kilgore, M.D., a gynecologic oncologist at UAB. “You don’t need progesterone when your uterus has been removed; estrogen alone is fine. But if you have a uterus, you should take estrogen and progesterone.”
Dr. Kilgore says that estrogen in a woman’s body causes thickening of the endometrium, or lining of the uterus. When estrogen’s effects are opposed by progesterone, as happens in a healthy menstrual cycle, the uterine lining is shed and the cycle begins again. But when a woman’s body fails to produce sufficient progesterone, or estrogen is administered unopposed, the endometrium continues to thicken and a woman’s risk of uterine cancer increases.
Postmenopausal women can help combat this process by taking combination hormone replacement therapy. Premenopausal women who use birth control pills, which usually contain both estrogen and progesterone, can get the same protective effect.
Combination hormone replacement therapy is not without its hazards. A 2002 study as part of the Women’s Health Initiative (WHI) showed a slightly increased risk of breast cancer, blood clots, heart disease, and stroke with the drug Prempro, which combines estrogen and the synthetic hormone progestin. However, while the study raises valid concerns, Dr. Kilgore says, it isn’t a blanket condemnation of hormone replacement therapy.
“The WHI study has lots and lots of supporters, but it has an equal number of critics,” he explains. “The primary criticism is that the majority of women who were in that trial are older than the woman who’s faced with a decision about initiating hormone replacement therapy at menopause. The average age of participants in the trial was around 60, whereas women enter menopause at around age 51. Most gynecologists agree that the trial results are not applicable to the 50- to 55-year-old woman who’s trying to transition herself from being estrogenized on her own to being estrogenized with replacement, who doesn’t want to wait 10 or 15 years until the effects of estrogen loss have taken a decade away from her vagina, bones, and skin.”
Estrogen is actually known to have a protective effect on the cardiovascular system for women in the 40- to 60-year-old age group, Dr. Kilgore says. This is in addition to its protective effect against osteoporosis and its effects on general health and quality of life in postmenopausal women.
The most important thing a woman can do, Dr. Kilgore says, is talk to her doctor to go over the risks and benefits of HRT as they apply to her own personal circumstances. “I think the more educated you are, the more you are able to make informed choices about HRT,” he says. This includes weighing the relative health dangers involved. “It’s unfortunate that many people just don’t hear anything else once they hear that HRT can increase the risk of breast cancer. Breast cancer is pretty common, but not as common as heart disease, and not as common as hip fractures. A lot more women die of hip fractures than die of breast cancer.”
Caperton Gillett