Weigh the Risks and Benefits of Hormone Replacement Therapy

PJ Hamel Health Guide
  • A stunning report in the December 15, 2006 New York Times, citing strong evidence linking hormone replacement therapy (HRT) with breast cancer, spawned a tidal wave of media coverage. It seems every paper across America picked up the story, which came out of the annual San Antonio Breast Cancer Symposium.

    The news detailed long-term results of the landmark Women's Health Initiative (WHI), prematurely halted in 2002 when researchers found overwhelming evidence of particular health risks among hormone users, most notably for stroke and breast cancer. In San Antonio, the results of further studies seemed to confirm those risks with long-term hard data: rates for the most common form of breast cancer dropped precipitously between August 2002 and December 2003, when many women stopped HRT.
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    This drop of 15 percent in just 16 months is the biggest decline in any specific type of cancer in any one year–ever. Pretty convincing, huh? If you were still on HRT, this was another big wake-up call to do some risk assessment.

    LATE-BREAKING NEWS: On April 16, the New England Journal of Medicine reported a follow-up study showing that the steep decline in breast cancer diagnoses in 2002-2003 was mirrored by an equal decline in 2004, indicating that the first drop wasn't just "a one-year wonder, a short-lived anomaly," according to Peter Ravdin, M.D., who headed the original study.

    "...the data present a very compelling link between hormone replacement therapy and breast cancer," said Donald Berry, Ph.D., the study's senior investigator. However, Berry added that these results don't point to all women immediately discontinuing HRT. "At best... an individual woman could reduce her individual risk of developing breast cancer by one in 60, or about 1.7 percent, if she stopped using hormones," he said.

    Ravdin added that women who choose to remain on HRT should use the drug at its lowest dose, and for the shortest period of time necessary in order to control debilitating menopause symptoms.

    Now that the frenzy has died down, many of us are taking another look at HRT, and wondering just where we stand. Many women, for many years, found great relief from menopausal symptoms through HRT.

    Menopause hits all of us differently; some (about 12 percent of us) sail through it practically unscathed, relieved at no longer having to fuss with monthly periods, but otherwise not feeling any different. Some undergo many months of peri-menopause, with its accompanying symptoms, extra-heavy periods being a common disturbing hallmark of this period.

    And most of us, when finally hit with full-blown menopause, experience some or all of a range of symptoms: hot flashes and/or drenching night sweats; sleeplessness; vaginal dryness, which leads to a host of other issues; and emotional problems, including anxiety and depression. For some of us–about 14 percent, studies show–these symptoms are intense enough to severely interfere with our lives.

    In the past, women took HRT not only to quell menopausal symptoms, but because we were told it could cut our risk of heart attack, and would keep us looking young. Well, we can ditch those latter two reasons; HRT doesn’t cut our risk of heart attack, and its ability to keep us looking young is questionable, too. But the fact is, HRT does minimize menopausal symptoms. Most likely at an increased risk of breast cancer. Decisions, decisions…

  • Drug manufacturers, chiefly Wyeth–maker of Premarin and Prempro, the most common HRT drugs–have reacted by selling lower-dose versions of HRT drugs, and advising women to take them for a shorter amount of time. Many doctors are urging their patients not to panic, but to take a good, hard look at how menopause is disrupting their life, vs. their chance of getting breast cancer or having a stroke.
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    Ask yourself: What are my existing breast cancer risks? If you haven’t had breast cancer, these may include family history, breast density, lifestyle, weight and activity level, all the things researchers have identified as putting a woman at increased risk.

    If you’re a survivor, you know your risk, probably right down to the last decimal point. Then ask yourself, how is menopause affecting me? Am I having so many hot flashes I can’t get a good night’s sleep, and my work and family life is impaired? Do I feel so anxious I have trouble functioning? Is making love so painful that I just can’t do it anymore… and how does that impact both me, and my partner?

    You may decide to play it entirely safe, and suffer through menopause no matter what the physical and emotional cost. Or you may decide that how awful you feel outweighs your cancer risk, so bring on those (low-dose) hormones. Either way, it’s YOUR decision, one of the most personal ones you’ll ever make. Don’t let the tide of public opinion drown out your own very important–and sensible–inner voice.

    Read more on a New England Journal of Medicine study form April 2007 linking use of HRT to inreased breast cancer incidence.

    Read more on the first HRT Award, of $1.5 million, awarded by a jury that found Prempro, Wyeth's hormone replacement therapy (HRT) drug, responsible for an Arkansas woman's.
Published On: January 30, 2007