Is Hormone Replacement Therapy Worth the Risks?

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Is Hormone Replacement Therapy Worth the Risks?

Pamela Merritt

News that there may be a link between hormone replacement therapy and lung cancer has renewed questions about the use of hormones to treat the symptoms of menopause.

It’s easy to miss reproductive health care news for all of the health care reform news breaking and unfolding of late, but recent news about a link between hormone replacement therapy and lung cancer is worthy of attention.  Hormone replacement therapy (HRT), once widely recommended to treat the symptoms of menopause, has been questioned since a 2002 study revealed an alarming increased risk of breast cancer for women on long-term HRT.

Lung cancer is the leading cause of cancer deaths for women in the United States.  Despite the alarm raised by the 2002 HRT study – it was halted as a result of the increased risk of developing breast cancer – short-term use of HRT (specifically estrogen and progestin) to treat the symptoms of natural menopause continues and many doctors and patients have determined that the risks of short-term treatment are acceptably low.  Now, with news that there may be a link between HRT and lung cancer, the use of hormones to treat the symptoms of menopause is once again being called into question.

HRT is the use of medications that contain female hormones to replace the hormones women no longer make after menopause.  Up until 2002, it was thought that HRT had long-term health benefits.  In 2002, a medical study was halted when it was discovered that study participants had an alarming increased risk for invasive breast cancer.  As a result of the 2002 HRT study, long-term use of HRT is no longer widely recommended.  Short-term use of HRT to treat the symptoms of menopause remains an option, with doctors and patients making the decision of whether or not to begin treatment on a case-by-case basis.

It is important to understand that short-term use of HRT is believed to have benefits above and beyond treating the symptoms of menopause.  Women are typically put on HRT, usually estrogen and progestin (man-made progesterone), during nonsurgical menopause. Estrogen is prescribed with progestin because estrogen can increase the risk of uterine cancer (women who undergo menopause after a hysterectomy can take estrogen alone.)  HRT can ease symptoms of menopause such as vaginal dryness, itching, burning and discomfort with intercourse.  It can also help ease the intensity and frequency of hot flashes associated with menopause.  Additional benefits of short-term HRT may include protection against osteoporosis, colorectal cancer and heart disease.

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There are also risks associated with HRT.  Patients taking estrogen and progestin may experience an increased risk of heart disease, breast cancer, stroke, blood clots and abnormal mammograms.  Women taking estrogen alone may have an increased risk of stroke, blood clots and abnormal mammograms.

Now, there is news that a new study has found patients between the ages of 50 and 76 taking estrogen with progestin may have an increased risk of lung cancer. 

Here’s what we know – the increased risk to patients on HRT developing lung cancer is connected with the duration of therapy.  The study, published in the pre-print online edition of the Journal of Clinical Oncology, found that women on HRT for 10 or more years had the greatest risk of developing lung cancer.  The risk of developing lung cancer for women on HRT (estrogen and progestin) for 10 or more years is 50 percent higher than for women not on HRT.  It is important to note that the increased risks associated with HRT are considered small compared to the risks associated with smoking.

For women who are considering whether to begin or continue HRT, these studies can be frustrating and alarming.  There is still no clear directive on what a “safe “duration of HRT is, but doctors will use these new finding to better counsel women about the risks and benefits of treatment.  There are risks associated with most medicine and women currently on HRT should consult with their doctor about what, if any, impact these new findings have regarding their individual treatment. 

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