Grillo: hormone replacement therapy

By Larry Matson

Grillo HealthInformation Center

Q: I've used hormone replacement therapy for hot flashes, and now I'm considering staying on it because I feel better. However, I'm concerned about breast cancer. Is this concern justified?

A: This question addresses the long-term use of hormone replacement therapy as a preventive health strategy for post-menopausal women. It's a different question than using hormones for menopausal symptoms such as hot flashes. The risks from short-term use are minimal, and the benefits are clear. The latest consensus statement (2013) from seven major international and U.S. societies working in women's health concluded that the benefits of hormone replacement therapy for treating moderate to severe symptoms outweigh the risks up to age 60 or 10 years post-menopause.

What about after 60? This can be a wonderful time of life, but chronic conditions such as heart disease, breast cancer, fractures, and dementia can threaten the quality of life.

Twenty years ago, hormone replacement therapy was widely considered beneficial for all of these conditions. Then, in 2002, the Women's Health Initiative, a massive National Institutes of Health-sponsored study of women's health issues, reported a significant increase in breast cancer in women using hormone replacement therapy. With this news, the number of women using the treatment plummeted from 18 million in 2001 to fewer than 6 million in 2008. Other studies have confirmed the link between hormone replacement therapy and breast cancer, although the absolute risk is quite low, especially under age 60. There is also a small increase in risk for clots in the lungs and strokes with long-term hormone replacement therapy. In view of these risks, no major medical associations recommend long-term treatment as a preventive strategy.

Ultimately, the decision to use hormonal therapy is an individual one, after weighing risks, benefits, and values with a trusted health care professional. For symptom relief, it's pretty simple the benefits are substantial but for preventive use, the hoped-for benefits have not been realized, other than reducing fracture risk. So, if osteoporosis is the primary issue, then hormone replacement therapy may be the right choice for the first decade.

For most women, risks are a more important consideration. The risk of breast cancer is often the tipping point. It begins to rise after approximately 3 to 5 years of the therapy and increases with longer use, personal or family history and lower body weight. The advice from experts is to use the lowest dose necessary to enhance quality of life and re-evaluate every six months to see if the benefits still outweigh the risks. The good news is that the risks decrease after treatment is discontinued.

Larry Matson, is a medical writer and health coach from Greeley and co-author of "Live Young, Think Young, Be Young ... at Any Age," Bull Publishing, Boulder, Oct 2012. He is a volunteer with the Grillo Health Information Center, which offers free and confidential research to help improve health decisions. Contact the Grillo Center located at 4715 Arapahoe Ave, by phone 720-854-7293, or via GrilloCenter.org. No research or assistance should be interpreted as medical advice. We encourage informed consultation with your physician or medical practitioner.

Excerpt from:
Grillo: hormone replacement therapy