HRT: Revisiting the Hormone Decision
It's been 5 years since studies proclaimed hormone replacement therapy a danger for women. WebMD investigates today’s changes and tells you what you need to know to make the HRT decision.
HRT and Breast Cancer continued...
But Smith says the back-story linking hormone use and breast cancer goes far
beyond just connecting a few incriminating dots. It's a complex
relationship, she says, that is still not fully explained – or explainable.
"What we have learned since the WHI is that for most women taking hormones
short term -- for two or three years for symptom relief -- there won't be an
increase in breast cancer in the short term, but this doesn't necessarily mean
these women won't see an increase in breast cancer in the long term," says
Stuenkel tells WebMD even Mother Nature validates this line of thinking.
"Population studies for a women who go into menopause at age 55
instead of 50, there is an overall increased risk of breast cancer, so the
duration of hormone stimulation definitely matters," says Stuenkel. Indeed, the
WHI showed breast cancer risks clearly increased the longer a woman remained on
At the same time, however, Goldstein notes that at least one reanalysis of
the WHI findings published in JAMA in 2006 found that women who had a
hysterectomy and used estrogen-only therapy for an average of seven years
had no increase in breast cancer rates.
"In fact, risks of at least one type of breast cancer were reduced in these
women," says Goldstein.
But again, Stuenkel reminds us that the duration of hormone use might change
that picture, too. She points to results from the Harvard Nurses' Health
Study published in the Archives of Internal Medicine in 2006, which
reported that those women who took estrogen only experienced an increase in
breast cancer after 20 years of use.
"I have not bought into the idea that estrogen alone reduces breast cancer,
and for me the duration of exposure is still a key issue – when it comes to
HRT, I just don't believe there's going to be a free lunch for any woman," says
Where We Are Today
While studies are still ongoing, and reanalysis of the original data
continues to shape our opinions, experts say there are a few lessons learned
thus far that are not likely to change.
Among them: That hormone replacement therapy is not a panacea for disease
prevention -- even in situations where it was found to be helpful, such as
reduction in hip fractures.
Moreover, if hormone replacement therapy must be used to quell menopause
symptoms, the lowest possible dose for the shortest possible duration is now
the standard of care.
Today the emphasis rests on the importance of treating every woman
individually, with decisions about hormone use made strictly on a case-by-case
"Gone forever are the days when every doctor routinely prescribed HRT for
every woman over 50; today, the decision to go on hormone therapy, even short
term, must take into consideration a host of individual health and lifestyle
factors," says Smith.