Hormone Replacement Therapy - How Safe Is It?

As women reach menopause, our bodies produce less estrogen. The lack of this hormone has been linked to osteoporosis, heart disease and strokes. Other uncomfortable symptoms, such as sweating and hot flashes are treated with hormone replacement therapy. One Internet site has a test to help determine if you should consider HRT. Until the suspicion that estrogen raised the risk of breast cancer became an issue, many doctors routinely recommended it to their post-menopausal patients. Many still do.

What are the facts about this treatment? The Society of Obstetricians and Gynaecologists of Canada reviewed data published on estrogen therapy and concluded that the risks involved are less than drinking alcohol excessively or not exercising. Each year in the United States 233,000 women die of cardiovascular disease. 90,000 do not survive strokes, another vascular condition. 65,000 die from complications of bone fractures as a result of osteoporosis. Only 43,000 die of breast cancer.

For many women the fear of breast cancer is much greater than their actual chance of contracting the disease. The risk of having a fatal heart attack is much higher. The survival rate is much better for breast cancer related to HRT than for any of the diseases that can be treated with hormone replacement.
 

The figures seem reassuring, and they may be for many women. The problem lies with those of us who are already at risk for breast cancer. Women who have no children or had their first child after 30 or who have a close relative with breast cancer are in this group. Many other women will get breast cancer due to factors that the medical community does not fully understand.

Studies of breast tissue show changes caused by HRT. According to a study published in February 2000 in The Journal of the National Cancer Institute the risk of getting breast cancer is ten percent for every five years of hormone replacement therapy. This is based on the combination of estrogen and progestin. Estrogen alone has a slightly lower risk. For women who know that they have a chance of facing breast cancer, any increased risk is frightening.

Add to this the studies that question the effectiveness of HRT. A report in the February 2000 issue of the Annals of the Rheumatic Diseases questioned the effectiveness of this treatment in osteoporosis. Other studies question whether replacement hormones really effect cardiovascular disease.

Alternative treatments to HRT exist. Exercise and aspirin increases cardiovascular health. Vitamin D and calcium supplements may be better choices for the woman with breast cancer and bone density concerns.

The final decision rests with us. It is, after all, our body that is at risk. Whether we opt for hormone replacement therapy should be based on rational analysis and not the latest media reports. The risks of getting breast cancer need to be weighed against our risk of heart disease, stroke or severe osteoporosis.

Consider the benefits of HRT before dismissing it, but discuss your individual risks with your doctor before taking it.

 

February 28, 2000

Last updated March 31, 2006

Elsewhere on the Web:

MedlinePlus - Hormone Replacement Therapy
Menopausal Hormone Use and Cancer: Questions and Answers
Alternatives to postmenopausal hormone therapy