Estrogen
Alone HRT Does Not Increase Risk of Breast Cancer, Increases
Risk of Stroke
According to a recent article published in the Journal of the
American Medical Association, hormone replacement
therapy (HRT) consisting of estrogen alone does not significantly
affect the incidence of breast cancer. However, the risk
of stroke with the use of estrogen-only HRT is significantly
increased and the Women’s Health Initiative Steering
Committee has recommended that HRT should not be used to
prevent chronic illness.
Hormone
replacement therapy (HRT) is often prescribed for women
during menopause. Menopause is a natural phase of maturing
womanhood, during which the ovaries produce significantly
less estrogen, ovulation ceases and menstruation ends.
For many women, menopause has uncomfortable side effects.
Hot flashes, sleep disturbances, depression, mood swings
and anxiety may affect the menopausal woman. Additionally,
menopause may also be accompanied by increased urinary
tract infections, incontinence, vaginal discomfort due
to a lack of estrogen-based lubrication and decreased bone
density. HRT has been effectively used to mitigate these
side effects and is widely prescribed for women experiencing
these unpleasant symptoms of menopause. Recent results
from several clinical studies have demonstrated a correlation
between the use of hormone therapy and the development
of breast cancer, as well as an increase from death caused
by breast cancer. HRT can contain estrogen alone, progesterone
alone or a combination of the two hormones. Research continues
in order to answers questions regarding different outcomes
for patients who use specific combinations or single-agent
HRT as well as duration of use.
The
Women’s Health Initiative (WHI) study was a large
study involving thousands of postmenopausal women to evaluate
the effects of HRT. One component of the WHI included women
who received estrogen-only HRT. These women were compared
to women who received placebo (inactive substitute)- (a
second component of the WHI that evaluated estrogen plus
progestin HRT was halted in 2002 due to the increase in
health risks with HRT compared to placebo). The estrogen-only
HRT component of WHI included over 10,000 women who were
aged 50 to 79 years who had a prior hysterectomy (surgical
removal of the uterus). After nearly 7 years of follow-up,
this component was halted due to the increase in the risk
of stroke by nearly 40% for patients treated with estrogen-only
HRT compared to those who received placebo. However, the
risk of coronary heart disease and bone fractures was decreased
in the group of women treated with estrogen-only HRT compared
to placebo. The incidence of breast cancer was not significantly
different in either group of women.
The
researchers and the WHI Steering Committee concluded that
HRT should not be used as a means to prevent chronic illness.
They stated that other medical means have been found to
be effective at reducing or preventing heart disease and
fractures that are not associated with an increase in other
health risks appeared to be caused by HRT. In addition,
the Food and Drug Administration recommends that estrogen-only
HRT should only be used for menopausal symptoms at the
lowest dose and for the shortest duration of time necessary.
Postmenopausal women considering HRT should speak with
their physician about their individual risks and benefits
of HRT.
Reference: The
Women’s Health Initiative Steering Committee. Effects
of conjugated equine estrogen in postmenopausal women with
hysterectomy. The Women’s Health Initiative Randomized
Controlled Trial. Journal of the American Medical Association.
2004;291:1701-1712.
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