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HRT for You
CONTROVERSIAL ISSUES
There are many promising studies on the advantages of HRT on the
horizon. The advantages of HRT remain highly controversial, because there is not
consistent research data to show that HRT may reduce the risk of cancer, heart
disease, Alzheimer’s disease, and other disorders. We will review several of
these controversial issues that warrant further studies.
Like any medication, HRT is not risk free. When facing menopause, HRT is a highly
individual decision. Women need to be
aware of their bodies, and their family’s medical history. Every woman should work with a doctor to
determine the pros and cons of HRT for her as an individual.
BLOOD CLOTS
Blood
clots are associated with hormone replacement therapy. Studies show an increase incidence of blood
clots in current users or short-term users hormone replacement therapy. After one year of use, the risk levels-off or
will not continue to increase (Basil & Mutch, 2001). Women should be encouraged not to begin the
use of hormone replacement therapy if problems with blood clots currently
exist. It is also noted that women who smoke cigarettes have an increased risk
of blood clots. The medication should be
discontinued if problems begin while taking hormone replacement therapy
(Lowdermilk, Bobak, & Perry, 2001).
BREAST CANCER
This is a highly controversial issue
in medicine today. Some studies show a
positive correlation of hormone replacement therapy and breast cancer while
others show no correlation. A study
conducted on 1400 women concluded that long term use (5 years or more) with
estrogen only or estrogen and progestin therapy resulted in an increased
incidence of lobular breast cancer (Barlow, Chen, Weiss, &
White,2002). Another study concludes
that hormone replacement therapy appears to greatly increase a woman’s risk of
breast cancer. Researchers found a 24%
increased risk for every 5 years use of combination (estrogen-progestin)
hormone therapy and a 10% increased risk with estrogen replacement therapy
(Ross, Paganini-Hill, Wan, & Pike, 2000).
However, the Nurses Health Study found and increased risk for long term
users and no risk of breast cancer in short term users (less than 5 years)
(Basil & Mutch, 2001). It is evident
that further research is needed to better define the balance of risks and
benefits of hormone replacement therapy and breast cancer. Hormone Replacement therapy; however, should
not be recommended for any woman with a blood relative who has had breast
cancer
(Lowdermilk, Bobak, & Perry, 2001).
CARDIOVASCULAR DISEASE
For many years health care providers believed estrogen provided
prevention against heart disease; however, last summer, 2001 surprising new
recommendations were made. The American
Heart Association announced that women with existing cardiovascular disease
should not take hormone replacement therapy for the prevention of heart attacks
and strokes. This recommendation is
based on the Heart and Estrogen Replacement Study (HERS), which found not benefit
of hormone replacement therapy to women with cardiovascular disease (
COGNITIVE SYMPTOMS
Some of the psychological symptoms that are
accompanied with menopause include: anxiety, tension, and moodiness. Over the years, several studies have demonstrated
a positive relationship between estrogen and mood enhancement. One study suggested a relationship between
HRT, and a decreased of cognitive dysfunction that is associated with
Alzheimer’s disease (Smith & Hughes, 1998).
The exact mechanism of estrogen on brain function is unknown. Estrogen
has been shown to improve blood flow to damaged vessels in the brain. Yet, recent studies have failed to support
this hypothesis (Manson & Martin, 2001). While it is too early to conclude,
HRT can reduce the risk of Alzheimer’s disease.
COLORECTAL CANCER
Colorectal cancer begins with the
development of benign polyps. As a polyp becomes malignant, it increases in size,
invades the colon wall and surrounds blood vessels, and spreads to other parts
of the body. There are studies that
suggest a reduction in the risk of colorectal cancer in women taking HRT. Two recent studies showed a 33% reduction in
the risk of colon cancer, and 8% reduction in the risk of colorectal
cancer. Finally, they found no
association between rectal cancers and hormone replacement therapy (Basil,
2001; Manson & Martin, 2001).
DIABETES
Recently, researchers in
ENDOMETRIAL CANCER
Women taking estrogen only therapy
have an increased risk for developing endometrial cancer. One study shows, that women who have taken
unopposed estrogen therapy were four times more likely to develop endometrial
cancer than non-hormone users (Beresford, 1997). Another study had similar findings and
concluded, that the risk of cancer was four to five times higher in women who
had used unopposed estrogen therapy. In
addition, the risk of endometrial cancer is greatest after the use of hormone
replacement therapy for 10 years or more (Basil & Mutch, 2001). However, when combination therapy is used
(estrogen and progestin) at an adequate dose there is no longer a risk
(Lowdermilk, Bobak, & Perry, 2001).
Again, it is important for women to consult a healthcare provider to
determine which type of therapy should be chosen to decrease the risk of developing
endometrial cancer.
GALLBLADDER DISEASE
The use of estrogen only therapy and
the development of gallbladder disease has been reported (Apgar, 2000). A risk is also seen in the use of combination
therapy (estrogen and progestin) (Lowdermilk, Bobak, & Perry, 2001).
Gallbladder disease results from the influence of estrogen on hepatic lipid
metabolism.
OVARIAN CANCER
The association of ovarian cancer and hormone
replacement therapy is very controversial.
Most studies say there is no increase risk of ovarian cancer with the
use of hormone replacement therapy.
However, more research needs to be conducted before conclusions can be
made. Doctors may be reluctant to prescribe hormone replacement therapy to
those with ovarian cancer, fearing the overall survival. Other studies have
shown a decreased risk of ovarian cancer and hormone replacement therapy.
Therefore, hormone replacement therapy for healthy women should not be viewed
as a risk factor for ovarian cancer (Basil & Mutch, 2001).
Home What is menopause Types of Hormone Replacement Therapy Advantages
Alternatives Complimentary Links
Is HRT for You