Cooling Down Hot Flashes: Is HRT Safe for You?

PJ Hamel Health Guide September 09, 2012
  • A decade ago, upwards of 15 million American women were using combination hormone replacement therapy (HRT) to help deal with their menopausal symptoms. Doctors also believed HRT protected women from a host of other issues, including heart attacks and osteoporosis.

    That all changed in 2002, when researchers learned that HRT drugs actually increased a woman’s risk of cardiac problems, stroke, and breast cancer – and millions of women dumped their bottles of HRT. Now, further research indicates HRT is indeed a legitimate treatment for severe hot flashes, mood swings, and other menopause-induced health challenges – for some women. Are you a candidate for HRT?


    Hot flashes. Drenching night sweats. Mood swings so severe you want to run and hide from family and friends.

    These are just some of the challenges many of us undergo as a result of menopause. And the hard part is, they usually come on top of the ravages chemo has already produced in us: the embarrassing baldness; the severe nausea; mouth sores, fatigue, neuropathy, chemo-brain…

    One of the less-noted chemo side effects is chemically induced menopause, which many women undergo during or directly following chemo. Chemo stops a woman’s reproductive system in its tracks; and for many, the days of a regular menstrual cycle become a thing of the past, replaced by a sudden trip through menopause.  

    Unfortunately, menopausal side effects can go on, and on… and on. For years. They may lessen in severity or frequency, particularly hot flashes; but they linger, impacting your life in ways you never would have predicted.

    Maybe your metabolism is permanently altered, your personal thermostat ratcheted up a few degrees. What used to be a comfortably warm summer day now feels distressingly hot, and you guiltily turn up the AC while your family complains about being cold.

    And then there’s “vaginal dryness” (read: painful sex). This side effect is supposed to respond to black cohosh, or olive oil, or [name your favorite home remedy], but usually it doesn’t. And years after menopause, you’re still suffering.

    Back in the day, you’d take a hormone replacement pill, and all of these menopausal side effects would magically disappear.

    But that was before 2002, when the ongoing Women’s Health Initiative study showed that the typical woman taking a combination of estrogen and progestin (e.g., Premarin) to deal with menopause was putting herself at significantly increased risk of heart attack, stroke, and breast cancer.

    Suddenly, millions of women stopped taking their daily “fountain of youth” pill. And began suffering.

    The good news? Fewer American women experiencing cardiac issues, stroke, and breast cancer. The WHI notes that since publishing the results of its study in 2002, and the resulting decrease in women using HRT, the number of breast cancer cases has dropped by 15,000 to 20,000 per year.

    The bad news? Researchers have found no treatment for hot flashes and those other menopausal woes that’s nearly as effective as HRT.


  • And women are tired of waiting for the next best thing to come along.


    In the past few years, as evidence from the WHI continues to mount, some doctors have softened their stance on HRT. It appears the pendulum may have swung too far back in 2002 (and again in 2006, when a New York Times article made many more women aware of HRT’s risks).

    Evidence now shows that some women – in fact, many women – can reap HRT’s benefits with just a minimal risk of its serious side effects.

    If you’re an otherwise healthy woman, a non-smoker of normal weight, not suffering from diabetes or high blood pressure; and you don’t have a family history or genetic predisposition to breast cancer or cardiac issues; and you’re no more than 5 years past the beginning of menopause; AND you’re experiencing menopausal side effects severe enough to impact your daily life, then a short (no more than 5 years) course of combination HRT will almost probably do you more good than harm.

    And if you’re a woman who’s had a hysterectomy, taking estrogen alone (without progestin) can not only quell those hot flashes and mood swings, it may also reduce – yes, reduce – your risk of breast cancer.

    So where does that leave us breast cancer survivors? We may meet all of the HRT-benefit criteria noted above except one: an increased risk for breast cancer.

    Talk about the rock and the hard place. The same hormone that would probably alleviate your severe hot flashes, painful sex, and thinning hair might also provoke a return of your cancer.

    MIGHT being the key word.

    If, for instance, you’ve been diagnosed with triple negative breast cancer, hormones apparently don’t have anything to do with whether or not you’ll suffer a recurrence. So if you’re suffering severely from menopausal symptoms, discuss with your oncologist whether HRT might be an option.

    Or if you’re many years past diagnosis, are recurrence-free, and are still bothered by those hot flashes and other side effects, then you might thoughtfully and seriously weigh the risks and benefits of HRT.

    How healthy am I, aside from a history of cancer? How high is my cancer recurrence risk right now? How much will I potentially raise my risk – of heart disease, stroke, and cancer – by taking a short course of HRT? (This is a question your oncologist can help answer.)

    Am I willing to trade a few percentage points of reduced cancer and other health risks for a big improvement in my day-to-day life? And finally, if I do choose HRT, and then experience a cancer recurrence, will I be able to get past the inevitable guilt and move forward without beating myself up too badly?

    Only you can answer these questions – and make the HRT choice.

    Sources

    Lloyd, J. (2012, July 08). 10 years after hormone therapy study: What doctors know now. Retrieved from http://www.usatoday.com/news/health/story/2012-07-08/hormone-therapy-menopause/56100846/1?csp=34news

    Tompa, R. (2012, June 25). Women's health initiative's landmark hormone replacement research 10 years after. Retrieved from http://www.fhcrc.org/en/news/center-news/2012/06/whi-hormone-therapy-10-years.html