Menopause is a natural process that all women experience as they age. During this time, hormone levels fluctuate, leading to a variety of symptoms such as hot flashes, night sweats, and mood swings. To alleviate these symptoms, many women turn to hormone replacement therapy (HRT). While HRT can be beneficial, it is important to understand the potential risks associated with it.
The most common risks associated with HRT are stroke, blood clots, and heart attack. However, recent evidence suggests that these risks are small and the benefits generally outweigh them. Studies have shown that taking estrogen alone does not significantly increase the risk of breast cancer. However, combined HRT may be associated with a small increase in the risk of breast cancer.
Because of this risk, it is especially important for women taking HRT to attend all breast cancer screening appointments. Hormone replacement therapy 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. For example, if 1000 women in their 50s took menopausal hormones for 5 years, they would be expected to develop an additional ovarian cancer. The decision to use estrogen, alone (ET) or with progestin therapy (EPT), after menopause should be made by each woman and her doctor, after weighing the possible risks and benefits.
Women who take only estrogen or have had their uterus removed by hysterectomy have a more favorable benefit-risk profile than those who take EPT. Several large studies have analyzed the possible links between systemic hormone therapy in menopausal women and different types of cancer. The results vary depending on the type of hormone therapy taken, how long it is taken for, and the individual's health risks. Generally speaking, if small doses are used, very little of the hormone is absorbed into the bloodstream, so it has little or no effect on the rest of the body.
The risk returns to that of a woman who never used EPT (the usual risk) three years after stopping taking the hormones. The United States Food and Drug Administration and Health Canada require that all prescription treatments containing estrogen include a “black box” warning in prescribing information about the adverse risks of HT. This warning is intended to help women make an informed decision about whether or not to use HRT. Overall, it is important for women to understand both the potential benefits and risks associated with hormone replacement therapy before making a decision about whether or not to use it. It is best to discuss any concerns with your doctor before starting HRT.