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WHAT’S HAPPENING?  WHAT DO I DO?
A GUIDE TO MENOPAUSE

HRT and Breast Cancer

At the heart of women’s uncertainty about HRT is the vital question of whether it increases the risk of breast cancer. There have been many studies attempting to answer this question but they simply do not agree. The studies finding an association get the most attention but there are many studies which have not found any increase. Let’s look at the worst case interpretation first. These studies find an increased risk overall of about 30% starting after five years on HRT. However, breast cancer found in women on HRT has a better prognosis -- one theory is that there is not more breast cancer but that it is diagnosed earlier. This means that breast cancer found in women on estrogen is more likely to be curable – but it does not guarantee that it will be.

Not long ago, I attended a medical symposium at which one speaker got up and said “There is now no doubt, HRT increases the risk of breast cancer”. At a later session, a different speaker got up and said, “There is now no doubt, HRT does not increase the risk of breast cancer”. If the experts do not agree, how can women decide who is correct? Obviously no one can. The honest answer is: “There is no doubt that we do not know if HRT increases the risk of breast cancer.” No one likes to admit that we don’t know something so important. But I think it is better to be up front about the limits of our knowledge.

Given this uncertainty, how can a woman make a decision? There are certain considerations which do help. First, studies suggest that because HRT does have health benefits, on average it increases women’s life spans by about a year. Some experts question the way the studies were done but no study has shown a decrease in lifespan. HRT decreases the risk of osteoporosis, and colon cancer. Most evidence suggests that it reduces overall heart disease risk but not in women who have already had a heart attack and possibly not in a few other women. This is being actively researched now.  Estrogen probably has other benefits not yet pinpointed. If there is an increased risk of breast cancer, it is small –which is why it has been so hard to tell if it is real.  And as I have discussed, the breast cancer found in women on HRT is more often curable. Since the overall effect on health and life expectancy  is positive, many women opt for HRT and feel comfortable doing so.

Still, many may still be asking: why would I consider taking it? The answer is of course, quality of life. Studies have shown that many women who have decided not to use HRT change their minds once menopause hits. They just do not feel well enough. Not long ago I was speaking to a prominent female physician who is an expert on menopause. She told me she is not entirely convinced that estrogen lengthens lifespan but she uses HRT anyway because she just does not feel well enough without it. This is a person who is extremely well informed  and highly regarded in her field who has no intention of slowing down because she has reached menopause.

 <- Previous page         Next page ->

What is Menopause?
When does menopause happen?
How Menopause Feels
What is HRT?
Surviving  – and thriving – during menopause
The big question: HRT
HRT and Breast Cancer
HRT and Contemporary Lifestyles
The HRT Option
How is HRT taken:
The different forms of estrogen:
Estrogen as a skin patch:
The splendors and miseries of progesterone
What are SERMs?
If you've had a hysterectomy
Deciding about YOUR Menopause
I'm on HRT but I don't feel any better
Conclusion

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