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Article Series: Menopause
Menopause Symptoms and Relief
Hormone
Replacement Therapy (HRT),
Cancer and Other Risks
Menopause is the complete disappearance of a woman's
monthly cycles for 6 to 12 months and is caused by declining production
of estrogen and progesterone hormones by the ovaries. When
the ovaries are removed, this is referred to as "surgical
menopause." Hormone-replacement therapy (HRT) provides
a postmenopausal woman with the absent hormone(s), although
not in the amounts once produced by the ovaries.
About 10 million women have been taking HRT, making these
drugs among the most prescribed in the United States. However,
new data call for a major reevaluation of this situation. After
an average of 5.2 years of follow-up on women on HRT, the data
showed increases in the risk of breast cancer, heart disease,
and stroke, but decreased risk of colon and rectal cancer,
uterine cancer, hip fracture, and death from other causes.
The only statistically significant findings, however, were
the reduced risk of fracture and colon and rectal cancer. The
researchers concluded that combined estrogen-progestin HRT
(a) should not be used on a population-wide basis for postmenopausal
women and (b) should not be started or continued for the purpose
of preventing coronary heart disease in apparently healthy
women. They also concluded that the risks should be considered
when choosing among the drugs available to prevent osteoporosis.
What
should women do? To begin with, they should realize that,
as with most scientific research, there are problems with the
WHI data, which allow them to be interpreted in various ways.
The average age at which women in this study began taking HRT,
for example, was 63.3 years, far beyond the age at which women
typically begin hormone replacement. In addition, because the
study lasted only 5.2 years, almost all of the extra breast
cancers would have been pre-existing based on what is known
about the biology of breast cancer. It has also been shown
that women diagnosed with breast cancer while taking HRT have
a better prognosis than those not taking HRT at the time of
diagnosis. Another serious problem with the study is that the
rates at which women chose to either begin or stop taking estrogen
on their own was high and exceeded the design projections of
the study. Many other issues have also been raised in scores
of letters to the editors and additional articles in the medical
literature. While this may seem confusing to consumers, this
is how real medical science works.
The most important thing for women who may be candidates for
HRT to keep in mind is that the goal of good medical care is
to live as long and healthfully as possible and not just to
avoid a particular disease. In addition, estrogen and progestins
are normal body hormones that are known to be important to
the function of many body tissues in women but which also affect
the risk of disease. For example, HRT reduces the risk of colon
and rectal cancer, a more deadly form of cancer than breast
cancer, although breast cancer is more common. Meanwhile, the
risk of breast cancer has been known for many years to be most
increased by an early onset of menstrual periods, a late age
of menopause, late or no childbearing, and absence of breastfeeding.
Women at an increased risk of breast cancer can even reduce
their risk by undergoing removal of their ovaries. The same
is likely true for other women, but it seems unlikely that
many would choose to undergo castration simply to reduce their
risk of breast cancer. In the end, it should be remembered
that life is full of risks and the challenge is to manage risk
since it can rarely be eliminated.
Although the report of results from the HRT arm of the WHI
study raises legitimate concerns, it did not show excess deaths
among users of the combined HRT treatment and does not apply
to all clinical situations. Meanwhile, cardiovascular disease
remains the leading cause of death in women as well as in men
and the most important risk factors for cardiovascular disease
have little to do with hormonal status. Therefore, with respect
to HRT, women should review their individual circumstances
with a knowledgeable physician to determine whether HRT makes
sense for them as part of an overall strategy to optimize their
health and reduce the risk of health problems and premature
death.
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SolveYourProblem.com
: 2006
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