HRT: Good, Bad, Good"¦ Now Bad Again?

Patient Expert

Hormone Replacement Therapy (HRT) is a godsend for women experiencing severe menopausal symptoms. Unfortunately, about 10 years ago researchers revealed a link between HRT use and an increased risk of breast cancer. Since then, HRT has been a bad idea; then maybe not so bad" but now seems to be heading back towards "don't go there."

If you're a woman, there'll come a time when you'll go through menopause - the end of your childbearing years.

Some women barely notice it, gliding right through "the change of life." Their periods become irregular, then stop. And that's it.

But for most of us, menopause means a good 1 to 2 years of potential hell: debilitating hot flashes, mood swings, painful sex, night sweats, thinning hair, anxiety, and depression are all fairly common. As is weight gain.

The only good thing about menopause? No more periods.

As with any health challenge, our first impulse is to visit the doctor and get a prescription: to quell the flashes and sweats, smooth the mood swings, take away the pain. And, up until about 10 years ago, there was a "magic pill" that addressed all of those menopausal side effects: HRT.

Most of the issues women experience during menopause are the result of a natural loss of estrogen, the female sex hormone. Decades ago, doctors found that replacing the loss of natural estrogen with that same hormone in pill form - paired with progestin, a synthesized version of another hormone, progesterone - made women feel like their pre-menopausal selves: happy, healthy, normal.

Life was good - until 2002, when the Women's Health Initiative (WHI), a long-term, ongoing study of women's health, revealed some starting information:

Women taking HRT were significantly more likely to be diagnosed with breast cancer.

Suddenly, the Prempro prescriptions dried up. Women stopped taking hormones. And within 5 years, there was a significant drop in breast cancer diagnoses: an estimated 15,000 to 20,000 fewer cases per year.

But those sometimes life-altering menopausal side effects remained. Studies of the connection between breast cancer and HRT continued.

Over the past few years, as data from the WHI continued to accumulate, many doctors came to believe that the pendulum might have swung too far back in 2002; perhaps HRT really wasn't the danger the study results led everyone to believe.

And women, particularly those unable to find relief from menopause any other way, started taking hormones again.

Fast forward to 2013 - and a new analysis of existing WHI data, published last month in the Journal of the National Cancer Institute.

According to researchers, this new study reveals that women who take HRT are more likely to be diagnosed with breast cancer, and more likely to die of breast cancer, than those who don't take HRT.

The pendulum has swung back. Doctors may very well back off recommending HRT, once again.

There's one exception to these findings: If you've had a hysterectomy, taking estrogen alone doesn't increase your risk of breast cancer; it's the estrogen/progestin combination that affects breast cancer risk. But since estrogen alone increases the risk of endometrial cancer, doctors won't prescribe it to women who still have a uterus - which is most of us.

If your menopausal symptoms are so severe that they affect your day-to-day life, you might still consider taking HRT as the lesser of two evils. But according to Patricia Ganz, director of cancer prevention and control research at UCLA's Jonsson Comprehensive Cancer Center, "If you're going to take these therapies, you need to know there's an increased risk. Make sure there's a good indication. And don't take them for a long period of time." (Brown, 2013)

Can't stand those hot flashes? HRT can help" but keep in mind the risk.


Brown, E. (2013, March 30). Study: Hormone therapy increases breast cancer risk, mortality. Retrieved from

Walsh, N. (2013, March 29). WHI: Combo HRT, breast cancer risk linked. Retrieved from