Many women in the United States begin short courses of hormone therapy, under the supervision of their doctor, to treat a variety of the symptoms of menopause and aging. When first invented, hormone replacement therapy, consisting of combinations of estrogen and progesterone, was touted as a natural fountain of youth for women, and as a way to stay healthy into their twilight years. All of this changed with the results of the Women’s Health Initiative in 2002 showed that estrogen plus progesterone hormone replacement therapy can lead to higher rates of coronary artery disease (heart disease), breast cancer, stroke and pulmonary embolism. This lead to a decrease in hormone replacement therapy in the United States, and a following decrease in breast cancer was observed.
The announcement of the results of the Women’s Health Initiative Study lead to approximately 2 out of 3 women discontinuing hormone replacement therapy.
While hormones are indeed natural substances, estrogen is even found in men albeit at lower concentrations than in women, hormones exert powerful effects on the cells in the human body. Many, if not most, hormones have a so-called “trophic effect” which means that they can program the cells in a certain organ to divide or multiple. As cancer is a disease of uncontrolled cell division, it is no surprise that the ingestion of hormones can as a medication can lead to a variety of cancers.
While hormone replacement therapy has been found to be dangerous when used for prolonged periods of time in older women, there are studies showing slight positive benefits under specific circumstances, such as in younger women. And short trials of hormone replacement therapy for the more acute symptoms of menopause such as hot flashes are still used for some women.
While older women, those above 60 years of age, who have arteriosclerosis in the arteries in their hearts may have a dangerously elevated risk of having a heart attack when placed on hormone replacement therapy, young women below the age of 60 may actually derive a small benefit from certain types of hormone replacement therapy. Research on the effects of hormone replacement therapy in younger women will likely further clarify the risk and benefits involved.
The FDA does recommend the use of hormone replacement therapy in women who have severe postmenopausal symptoms, such as hot flashes, vaginal dryness, loss of sexuality, difficulty sleeping, mood changes, joint stiffness, and joint pain. Usually a woman’s physician will prescribe the hormone replacement therapy for limited period of time as increased time on hormone replacement therapy, for years or even decades, is though to greatly increase the risk of diseases such as breast cancer. When used for severe postmenopausal symptoms, doctors will usually prescribe a very low dose of the hormones in the hormone replacement therapy.
A new study recently conclude that women on hormone replacement therapy who develop breast tenderness are at increased of developing breast cancer. Women on hormone replacement therapy who experience breast tenderness are about 48 percent more likely to develop invasive breast cancer than women on hormone replacement therapy who do not experience breast tenderness.
A possible explanation for this result could be that breast tenderness in a given patient means that her breast tissue is sensitive, or vulnerable, to exogenous hormones such as estrogen and progesterone, in some manner such that cells in her breast may enlarge and product breast tenderness. Such responsiveness of cells in the breast to enlarge due to hormone replacement therapy may mean that these cells are more likely to enterinto uncontrolled growth and become cancerous. Of course, this is all conjecture, and likely more studies will be completed in the future.
However, the study’s authors concluded that breast tenderness in a women receiving hormone replacement therapy “may be a marker of increased breast cancer risk.”
Undoubtedly, more research is needed to elucidate what role hormone replacement therapy has for women who may be candidates for the therapy. Different formulations of hormone replacement therapy, such as lower doses, and using patches which may deliver the medication in a more physiologically manner similar to how the body normally secrets estrogen and other hormones, may improve the safety of these medications for women who need them to relieve severe postmenopausal symptoms.
Sources:
HRT: Where Are We Now?
http://www.webmd.com/menopause/guide/hormone-replacement-therapy
Women’s Health Initiative
http://en.wikipedia.org/wiki/Women’s_Health_Initiative
For women on HRT, tenderness may be a warning sign
http://www.reuters.com/article/latestCrisis/idUSN12151041
