Beyond the Headlines: Evaluating HRT Risks

A magazine in my waiting room cites a study that suggests 40 ounces of caffeinated coffee a day to prevent memory loss. The downside, of course, is that you may not sleep at night—which would certainly interfere with my brain function! You may have heart palpitations. And you may become dehydrated. As with any decision about your health, there are trade-offs and implications to consider.

That’s the message I’m sharing with patients who have more anxiety about hormone options after last month’s report from the Women’s Health Initiative (WHI) on a link between hormone therapy and breast cancer. Complexities and trade-offs don’t make good headlines, but we need to think them through to make decisions about our own health.

Here are a few of the things beyond the headlines I’d like women to consider before ruling out any kind of hormone therapy:

Every death from breast cancer is, of course, tragic. Too many women are fighting this disease. But for context, the increased risk the WHI points to is 1 in 10,000. According to the National Cancer Institute, 12.2 percent of American women will be diagnosed with breast cancer at some point in their lives.

The data reviewed by the WHI was of a study using a particular combination of synthetic hormones: estrogen plus progesterone. What’s underreported is that there was a decrease of 23 percent in breast cancer risk with estrogen alone, and that the study did not compare other formulations of hormones.

The age at which menopause happens plays a part in breast cancer risk. The risk from hormone therapy described in the study is roughly the same as the increased risk that happens naturally if a woman’s menopause happens five years later—because of the longer exposure to her own natural estrogen and progesterone.

Obesity is a risk factor I wish got more attention: Women who are 20 pounds or more overweight when perimenopausal are twice as likely to develop breast cancer after menopause, and nearly half of breast cancer patients are obese (nearly half of U.S. citizens, too). Fat tissue produces estrogen, which gives an obese menopausal woman higher estrogen levels than women of healthy weight.

Quality of life counts, too, in evaluating risk, as a friend realized when she found her 80-year-old mother up a tree picking apples. My own mother would have benefited from the bone health that hormone therapy can provide. She had a hip replacement in her 50s and didn’t walk again. My bone health, on the other hand, is still good, partly as a result of careful hormone therapy.

If your menopause symptoms make you miserable, I’d encourage you to consider all of the options open to you. Consider your entire health picture, including your medical history, your weight, and how active you are. A good menopause care provider can help you explore your options and risks, and, if it’s appropriate for you, prescribe the lowest effective level of the fewest possible hormones for a period of time to help you through the symptoms that are keeping you from living the life you’d like.


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