Is there an increased risk of cancer with hormone replacement therapy?

The question of an increased risk of breast cancer in connection with hormone replacement therapy (HRT) is complex and requires careful consideration of the available data and information as well as individual advice from the patient and her doctor.

In the past, studies such as the Women’s Health Initiative (WHI) have indicated that certain forms of hormone replacement therapy may be associated with an increased risk of breast cancer, particularly with long-term use.

As a result, hormone replacement therapy has been used less for the prevention of diseases such as osteoporosis and for the treatment of menopausal symptoms.

In the meantime, further studies have been carried out that provide a more differentiated view.

New studies have shown that the risk of breast cancer can vary depending on the type of hormones used, the duration of use, the time of the start of therapy and individual risk factors.

For example, a lower oestrogen dose, local (topical) application or the use of certain hormone preparations can reduce the risk of breast cancer.

The infamous WHI study

The fear of side effects was triggered by a study published in October 2002 by the Women’s Health Initiative, the data from which had been misinterpreted and misrepresented for years.

The study involved postmenopausal women with an average age of 62 who had taken hormones at some point and were mostly overweight.

The results of the Women’s Health Initiative (WHI) were further analyzed and interpreted in the years following their publication, and some of the original conclusions were revised or changed. One important revision concerned the interpretation of the results on hormone replacement therapy (HRT) and its effects on the risk of cardiovascular disease and breast cancer.

The revision was made for several reasons:

1. Differences between the treatment groups: The WHI study included a heterogeneous group of women with different characteristics and risk profiles. Some women started hormone therapy after menopause, others later. This led to different effects of hormone therapy depending on the time of treatment initiation and other individual factors.

• Type of hormones used: The WHI study used specific forms of estrogens and progestins for hormone replacement therapy. It was found that different hormone preparations can have different effects on health. Therefore, the results of the WHI study cannot necessarily be applied to other hormone preparations.

• Long-term analysis: As the duration of follow-up increased, further data was collected that enabled a more precise assessment of the long-term effects of hormone therapy. This led to a more differentiated view of the risks and benefits of hormone replacement therapy.

OK and what does this mean for me?

Under no circumstances should hormones be taken blindly. Hormones are not the solution for every woman. The first step is always to talk to your doctor. And once the decision to take hormones has been made, you should only take them for as long as necessary.

The optimal «window» should also be used for hormone replacement therapy. This describes the period of 10 years after the last menstrual period. If this window is missed, the symptoms can have serious physical consequences.

You should also pay attention to your body. If you feel well during the break without hormones, it is very likely that you will be able to manage without them.

And when should I take hormones now?

If the menopausal symptoms are severely affecting your quality of life, hormones should also be considered. The dosage is adjusted individually and bioidentical hormones are also available today. It should be noted that oestrogen treatment must be combined with the intake of progesterone in order to protect the uterus (against cancer). In terms of dosage forms, transdermal applications such as patches or creams are preferable to oral intake.

To summarize, we can list the following advantages and disadvantages of hormone therapy:

Advantages

• Protects against osteoporosis
• Helps with menopausal symptoms (see the explanations of menopausal symptoms)
• Reduces the risk of heart disease.

Disadvantages

• Oestrogen must be taken with progesterone.
• The risk of breast cancer is slightly increased with combined preparations.
• When taken orally, there is a slightly increased risk of blood clots and stroke.

Should I be afraid of hormone therapy?

Every woman is unique and is entitled to individual treatment. If you are afraid of hormone therapy, don’t let anyone talk you into it.

Lifestyle changes and herbal remedies can also alleviate the symptoms. In principle, no woman should have to suffer.

However, it is important to be aware of the disadvantages that arise if nothing is done.

And remember that everyone has an increased risk of cancer in midlife and that this is not necessarily related to hormones.

Talk to your doctor

It is important to emphasize that the decision to use hormone replacement therapy is individual and should be made in consultation with a qualified medical professional. Women should consider their own risk factors for breast cancer, their menopausal symptoms and their preferences when weighing up the possible advantages and disadvantages of hormone replacement therapy.

Regular check-ups and open communication with the doctor are also important to minimize the risk and ensure the best possible treatment.

We hope this information will help you to better understand the menopause and take practical steps to deal with it. If you need personal advice or support on your journey through the menopause, contact The Women Circle here.

In our next edition, again on Saturday at 9am, we will cover more aspects of the menopause and women’s health. Stay informed and feel good in this special phase of life.