The Hormone Therapy - Breast Cancer Connection

Is Hormone Therapy for You?

A woman who isn't miserable during menopause likely has no need for hormones and shouldn't take them, said doctors we consulted. But if you're part of the following two groups of women, you still may benefit from these medications.

"Symptoms of menopause can include hot flashes, night sweats, sleep problems, vaginal dryness, irritability, heart palpitations, and headaches," says Alan Altman, MD, assistant clinical professor of obstetrics, gynecology, and reproductive biology at Harvard Medical School. Research shows that about 75 percent of menopausal women experience hot flashes -- and about a third of those have severe symptoms, getting more than 10 a day.

Women with debilitating symptoms may feel so much better on hormones that they and their doctors believe the quality-of-life benefits outweigh the risks. "Women need to have a conversation with their physicians," says breast cancer expert Etta Pisano, MD, Kenan professor of radiology and biomedical engineering at the University of North Carolina at Chapel Hill. "We can't say categorically that no one should get estrogens. Some women have such hellish menopausal symptoms -- the inability to have intercourse because the vaginal tissue is so fragile that it bleeds, for example -- and estrogens are the best treatment for them."

The FDA and major medical groups agree that hormones are a reasonable treatment for women whose debilitating symptoms can't be relieved in other ways, through vaginal lubricants, sleep medications, and a variety of other products. They also caution that the drugs should be used at the lowest-effective dose for the shortest length of time and that doctors should closely monitor a woman on hormones to help wean her off them as soon as possible.

In deciding whether your menopause symptoms warrant using hormones, weigh the concerns about breast cancer against the other risks and benefits of the drugs. In addition to relief of symptoms, studies show that HT lowers the risk of colon cancer, boosts bone health, and dramatically lowers the chance of hip fracture. On the other side of the scale, taking hormones probably increases the risk of stroke and blood clots -- but the danger seems to depend on how early in menopause you take them.

Doctors suggest trying other bone treatments first (bisphosphonates and raloxifene are among the most common ones). But for women who suffer severe side effects on other drugs or who don't want to use them, hormone treatment for bone health may be recommended. "Also, if a woman is losing bone and having hot flashes, my personal opinion, based on the literature, is that if she takes hormones for the first five years after menopause she has done herself significant good," says Wulf Utian, MD, PhD, executive director of the North American Menopause Society. "When she comes off hormones, she'll be a bit older and can go on one of the bisphosphonate drugs for her skeleton. This avoids all these years on bisphosponates because we don't know the long-term effects of those, either."