HRT Raises Risk of Breast Cancer Death
Combined Hormone Replacement Therapy May Be more Deadly for Some
Sorting Out the Risks and Benefits of HRT
To help women make sense of the confusion surrounding HRT,
WebMD consulted an expert, JoAnn V. Pinkerton, MD, director of the Mid-life
Health Center at the University of Virginia in Charlottesville and chairwoman
of the professional education committee of the North American Menopause
Q. Who should be concerned about these and other recent
studies on hormone replacement therapy?
A. I think there are two main groups of women who are most
concerned with HRT issues.
First, there are the women with significant menopausal
symptoms, such as hot flashes, and are considering going on HRT.
The second group of women are those who have been on HRT for a
long time, have read the recent information on HRT, decided to transition off
HRT, and now have not fared well in terms of having significant menopausal
Q. For women thinking of starting HRT for relief of
menopausal symptoms, what are some alternative options to consider?
A. About 25% of menopausal women have significant symptoms, and
about 15% of those have moderate to severe symptoms, enough that they affect
the woman's quality of life. That usually means more than 10 hot flashes a day,
waking up several times during the night with night sweats, difficulty
concentrating, and possibly vaginal dryness and pain during intercourse.
For people with milder symptoms, we first try lifestyle
- Wearing lighter, layered clothing
- Using fans and air conditioning
- Avoiding hot flash triggers, such as spicy food or wine
- Learning relaxation techniques or paced breathing
For people with more frequent hot flashes, we may try
over-the-counter remedies with the understanding that we have limited data on
their safety and effectiveness, such as:
- Black cohosh
- Soy products
- Phytoestrogens (plant-based estrogen-like substances), such as red
What we know from studies is that these over-the-counter
products work about as well as a placebo or sometimes a little bit worse.
Q. What's left for women with more severe symptoms that
aren't relieved by alternative methods?
A. These women will need some type of medical intervention, and
without a doubt hormone replacement therapy is the most effective. It works 95%
to 98% of the time, and it works with both mild as well as the more intense or
severe hot flashes.
For women who don't want to go on hormones or those for whom
HRT is not recommended, such as those with a history of breast cancer, we are
trying low-dose antidepressants. These drugs are showing an effectiveness at
relieving hot flashes of between 30%-60%, and we can get effective treatment in
that range at lower doses than are needed to treat depression, so hopefully
there are fewer side effects.
Q. How do you discuss the risks and benefits of HRT with
women who need relief from menopausal symptoms?