New Breast Cancer Risk Found With Hormone Replacement Therapy
"What I don't like, and I see this every day, is women who've been on estrogen for years for no specific reason," Cosman says. "I ask them why, and they say, 'I don't know, my doctor put me on it.' The conclusion is that we all should have a reason for being on hormones. And if we take them, we should be on the lowest possible dose of [progestin]."
Schairer and her colleagues stop short of offering guidelines for HRT use, but Willett and his colleagues at Harvard attempt to sort out this controversial and perplexing issue. They write that short term use to quell menopausal symptoms, with a two to three-year course of treatment, "should not be influenced by fear of cancer risks." Secondly, for women without a uterus, the combination therapy is unwarranted anyway, because there is no need for the progestin and its beneficial effects on the uterus.
But for the third group of menopausal women with a uterus, who comprise the vast majority of HRT users, the questions of benefit vs. risk doesn't have such tidy answers. "[R]educing the risks of fractures and heart disease will rarely provide sufficient justification because avoidance of smoking, performance of regular exercise, and consuming a good diet are effective preventive measures," they write. They point out that there are many new medications that can be used for heart disease and osteoporosis prevention that were not available in the past.
"The commonly held belief that aging routinely requires pharmacological management has unfortunately led to neglect of diet and lifestyle as the primary means to achieve healthy aging," they write. "Now is an appropriate time to reassess this emphasis."
Cosman says the decision to stop -- or start HRT -- isn't easy. "I have to tell you that I have patients who've been on long term estrogens who don't want to change. They think they look better, they feel better, the skin is better, the hair is better. Although this isn't true disease prevention, it probably is a quality of life issue that has to be considered with some women."