Hormone replacement therapy (HRT) is a popular treatment for menopausal symptoms, but it is important to understand the risks and benefits associated with it. Recent evidence suggests that the risks of HRT are small and the benefits generally outweigh them. There is little or no change in the risk of breast cancer if you take estrogen-only hormone replacement therapy. Combined hormone therapy may be associated with a small increase in the risk of breast cancer.
Because of this risk, it is important to attend all breast cancer screening appointments if you are taking hormone therapy. HRT does not significantly increase the risk of cardiovascular disease (including heart disease and stroke) when started before age 60, and may even reduce the risk. It has also been linked to benefits in several chronic diseases such as osteoporosis, colorectal cancer, and depression; it may also have a protective role in dementia and cognitive decline in postmenopausal women. However, HRT from 1 to 7 years is associated with an increased risk of breast cancer, stroke, and venous thromboembolism.
Ovarian and endometrial cancers have been associated with unopposed estrogens and unopposed or sequential regimens, respectively, and continuous treatment with a combination of estrogen and progestin appears to protect against endometrial cancer. Unlike observational studies, recent randomized controlled trials showed an increased risk of coronary heart disease associated with HRT. A modest increase in the risk of gallstones and possibly gallbladder cancer has also been observed, but there is still little evidence. If your uterus hasn't been removed, your doctor will normally prescribe estrogen along with progesterone or progestin (a drug similar to progesterone).
This is because estrogen alone, when not balanced by progesterone, can stimulate the growth of the uterine lining, increasing the risk of endometrial cancer. If your uterus has been removed (hysterectomy), you may not need to take progestin. Taking HRT tablets is associated with a small increase in the risk of stroke, but the risk of stroke in women under 60 is generally very low, so the overall risk remains small. The prevention of chronic diseases, in particular osteoporosis, has been one of the main considerations when prescribing hormone replacement therapy, but it is necessary to review the possible risks.
The effect of HRT on increasing risk is limited to the five-year treatment period, but the effect on quality of life and mortality occurs more than five years after the onset of the disease. When deciding whether to undergo HRT, it's important to understand the benefits and risks. Women without menopausal symptoms showed net harm due to the use of HRT, which increased as the initial risk of breast cancer increased. The main analysis showed that hormone replacement therapy is beneficial in women with symptoms, and that the benefit decreases as the baseline risk of breast cancer increases.
We evaluate high-risk levels to determine the suitability of HRT in women with BRCA1 or BRCA2 gene mutations, in whom the risk of breast cancer can approach 50%. The loss in stroke associated with the use of HRT for five years was 0.2 months in perfect health (- 0.02 HVAC) for women at low risk (0.7%), 0.4 (- 0.03) for women at average risk (1.2%), and 2.4 (- 0.20) for women at very high risk (50%). It is important to talk to a family doctor if you are thinking about starting HRT or if you are already taking it and are concerned about the risks. The decline in quality values associated with the use of HRT for five years ranged from about seven days in perfect health for women with the lowest initial risk (0.7%) and two and a half months for those with a high baseline risk (12%).
Ultimately, understanding both the benefits and risks associated with hormone replacement therapy can help you make an informed decision.