Health Watch: Hormone Replacement Therapy

Dr. Brett Parkinson with Mountain Medical breaks down the risks.

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Although women and their doctors have known for several years that combined hormone replacement therapy–estrogen and progesterone used together–can increase the risk of heart disease and breast cancer, a new study from the Los Angeles Biomedical Research Institute at Harbor–UCLA Medical Center suggests that combined hormone replacement therapy (HRT) has an additional downside: It increases the frequency of abnormal mammograms and breast biopsies. The study also confirmed something else researchers have known for the last few years–it also increases the risk of breast cancer. But should women who currently rely on hormones for menopausal symptoms discontinue their use, simply because of these risks? Not necessarily. Like so many things in life, there are trade-offs, and there are so many variables to the menopause equation that no solution fits all women. Each woman must weigh the risks and benefits for herself.

HOW DOES HRT ADVERSELY AFFECT MAMMOGRAMS?

• It causes an overall increase in breast density, which makes the mammogram somewhat more difficult to interpret. The breast is made up of several elements: fatty tissue, fibroglandular tissue (including the milk-producing glands and ducts) and connective tissue. The fat is gray or black on the mammogram; the connective and fibroglandular tissue are white. Cancer is usually white too. So anything that increases the white background has the potential to obscure a cancer on the mammogram.

• Hormones can cause proliferation of benign conditions, like cysts or fibrocystic changes, that usually require further evaluation with additional mammographic views and ultrasound.

RESULTS OF THE BIOMEDICAL RESEARCH INSTITUTE STUDY:

• Mammograms with abnormal results were more common in women taking hormones than in the placebo group (35 vs.23%).

• Breast biopsies were more common in the women taking hormones (10 vs. 6%)

• Breast cancers were significantly increased in the HRT group (199 women in the hormone group, 150 in the placebo group)

• There were more false positive biopsies in the hormone group.

• Women in the HRT group were diagnosed on average at a later stage.

SO WHY DO WOMEN CONTINUE TO TAKE HORMONES IF IT NOT ONLY INCREASES THE RISK OF ABNORMAL MAMMOGRAMS, BREAST CANCER AND HEART DISEASE?

• Because it is the most effective way to treat the symptoms of menopause.

In the past, HRT was widely recommended for the treatment of menopause and associated symptoms, as well as for the prevention of osteoporosis and heart disease. (Of course, we now know that hormones are not beneficial to the heart.) However, since the publication of the Women’s Health Initiative Study in 2003, hormone use has dropped off dramatically.

WHAT EXACTLY IS HORMONE REPLACEMENT THERAPY?

• Before menopause, a woman’s ovaries produce two major hormones: estrogen and progesterone. However, after menopause, the body no longer produces adequate amounts of these hormones, so HRT is given to restore the prior hormonal milieu. Lowered or fluctuating levels of these hormones can cause a variety of symptoms, ranging from hot flashes to alterations in mood.

WHAT ARE THE TYPES OF HRT?

• Estrogen Therapy: This can be prescribed alone, only if a woman no longer has a uterus, as estrogen can cause uterine cancer. Can be taken as a pill, patch or a cream.

• Combined Therapy: Progesterone/Progestin-Estrogen: When estrogen is taken with progesterone, the risk of developing uterine cancer is reduced.

Women should take the lowest dose that is effective for treating symptoms. In addition, prolonged use is discouraged.

HORMONE THERAPY IS APPROPRIATE FOR THE FOLLOWING SYMPTOMS:

• Hot flashes.

• Vaginal dryness that can result in painful intercourse.

• Dry, itchy skin

• Night sweats

OTHER BENEFITS OF HRT:

• Reduces risk of osteoporosis and fracture

• Improves mood and sense of well-being in some women

• Decreases tooth loss

• Lowers risk of colon cancer

RISKS OF HRT:

• Endometrial Cancer

• Blood clots

• Stroke

• Increase risk of heart disease in women taking combination therapy. Not in women taking just estrogen.

Any woman contemplating beginning hormone therapy should have a thorough discussion concerning whether the benefits really do outweigh the risks.

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ABOUT MOUNTAIN MEDICAL PHYSICIAN SPECIALISTS

Mountain Medical Physician Specialists is a partnership of over 50 board-certified radiology and vascular professionals providing patients along the Northern Wasatch Front with the latest imaging and vascular care available. Mountain Medical professionals specialize in vascular surgery, vascular and interventional radiology, CT, neuroradiology, orthopedic imaging, MRI, women’s imaging, ultrasound, nuclear medicine and body imaging.