Hormonal Treatment & Breast Cancer

The Women’s Health Initiative study in 2002, released results that hormone therapy for women during their peri-menopausal and menopausal years was considered harmful, citing an increase risk of breast cancer, stroke, heart disease and blood clots. In fact, the study was discontinued in July 2002 by NIH officials stating “the associated health risks of the combination hormone therapy outweighed the benefits.” Those benefits included a reduction in colorectal cancer and hip fractures.

But before we go any further, let’s clear up some confusion in terms. The other day a patient told me she was going through the menopause. I said, “You can’t go through the menopause.” All menopause means is “no period” for a year and the average age is 51. Sometimes you see the term climacteric, and that is the period of time the woman’s ovaries begins to decrease producing hormones, especially estrogen. Menstrual periods become lighter and further apart and symptoms like irritability, hot flashes, anxiety, depression and sexual dysfunction occur. Peri-menopause is the time between the climacteric and menopause.

Now that’s clear, what did this new study say? The Women’s Health Initiative published their information recently in the Journal of the American Medical Association. They looked just at postmenopausal women, 50-79 years old, who had a hysterectomy and took only estrogen hormone for about 6 years. These women were followed for about 10 years, so their risk and benefits of taking hormones were looked at during and after treatment, and both groups had a decrease in breast cancer.
Women in their 50’s seemed to have greater safety and benefits from hormone treatments, with a decrease in hip fractures and colorectal cancer, but an increase in strokes and blood clots. Women over 70 fared worse; they had an increase in heart disease, colorectal cancer, death rate and chronic diseases. Across the board, hormones did not seem to affect heart disease, improve mental capabilities or reduce Alzheimer’s disease.

Now let’s look back at the original study, where the released results looked at women who took combination hormone treatment that included estrogen and progesterone, and did not have a hysterectomy. Many professionals felt the information from The Women’s Health Initiative of 2002 was misinterpreted or over generalized. Reputable research physicians warned of the study’s limitations, including some of the original investigators, but fear had already been released by the media. Frightened women stopped from taking hormones, leaving many to suffer their peri-menopausal symptoms in silence and be denied any additional benefits. Perhaps with this new information there will be open roads to re-look at the entire study and provide the public with a more usable assessment.

Many health providers feel women can take hormones for short periods of time, especially since most peri-menopausal symptoms only last 1-2 years. That doesn’t mean some unlucky women won’t experience them longer. But as with any medications, it is important to have a thorough conversation with your physician to identify your individual risk. Personal and family history is extremely important. Women in their 70s, history of chronic liver disease, history of uterine cancer, undiagnosed vaginal bleeding, those diagnosed with estrogen-positive breast cancer, history of heart disease or blood clots may need to avoid the hormone treatment and seek other options.

Any woman who considers taking hormones should consult with a specialist experienced with hormone therapy. If you have habits that are unhealthy, like smoking, drinking, poor nutrition, lack of exercise, obesity and stress, you need to make changes. Pay close attention to your body, if you are on hormones and have symptoms like chest pain, leg cramps/swelling or you just don’t feel good, you may need to stop taking your hormones and contact your physician.

Remember, you control your options and quality of life, stay educated.