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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 Society.

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 symptoms.

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 changes, including:

  • 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 clover

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?

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