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The Making of Medicine

Reassuring News About Menopause Hormone Therapy

Hormone therapy is used to treat many menopause symptoms, such as hot flashes and night sweats, but there has been conflicting information about whether or how much it increases women's cancer risk. Two of our menopause experts, however, say that a new review article and other recent findings should reassure both women who are considering the treatment and their doctors.

In an editorial accompanying the new review, our JoAnn V. Pinkerton, MD,the executive director emeritus of the North American Menopause Society, and our Carolyn S. Wilson, MD, weigh in on the issue of cancer risk from hormone therapy. The editorial was written in conjunction with Andrew M. Kaunitz, MD, of the University of Florida College of Medicine – Jacksonville.

The review article, the editorial authors say, makes a strong case that hormone therapy does not increase the risk of invasive breast cancer for women who have received a hysterectomy. 

Estrogen combined with progesterone, however, ups breast cancer risk for women who have not received a hysterectomy, especially when used long-term. But the editorial authors point to another study indicating that did not translate into a higher risk of death.

Further, the authors note that not all progestogens – medicines that protect the uterus from estrogen-stimulated cancer – carry equal breast cancer risk. It appears that estrogen combined with micronized progesterone and dydrogesterone does not add to breast-cancer risk as much as other combinations, if at all. (Dydrogesterone has been discontinued in the United States in favor of other progestogens, but it remains widely available in other parts of the world.)

The editorial urges women to discuss the benefits and potential risks of the treatment with their doctors. If they opt for the therapy, they should revisit that discussion periodically as they receive breast exams and imaging. 

“Let’s replace fear with knowledge,” Dr. Pinkerton said. “Most healthy women under age 60 or within 10 years of having their last period and having bothersome symptoms can take hormone therapy without fear at menopause if taking estrogen alone or combined with progesterone.” 

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