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Time and again, I hear many women tell me that their previous provider told them that Hormone Replacement Therapy (HRT) causes cancer. Some women who were already on HRT were told to start reducing their dose and completely go off their hormones for fear of it causing cancer. These women have had to suffer symptoms related to peri or post menopause. Why is this so? A 2002 Women's Health Initiative (WHI) trial studied the effects of estrogen-progestin in women. It resulted in misinformation that unfortunately continues to mislead many health care providers and patients. This trial linked HRT to breast cancer and heart disease. One big problem from this trial is that it focused on women over the age of 60. The results were then generalized to younger women. The other problem was that the results of increased risk of breast cancer and heart disease were not statistically significant. Although the WHI demonstrated increased risk of cardiovascular disease with HRT in the overall cohort in the trial, subsequent secondary analyses demonstrated that these risks were influenced by the woman's age and time since menopause. The absolute risks is reduced for younger women than older women (Chester et al., 2018).
Vogel L. Trial overstated HRT risk for younger women. CMAJ. 2017;189(17):E648-E649. doi:10.1503/cmaj.1095421
In my practice, I have seen HRT improve quality of life for many women. We use the Menopause Rating Scale or the MRS to assess symptoms before and after starting HRT. We have seen amazing clinical improvements in the following symptoms:
vaginal dryness
anxiety
hot flashes
sweating
weight loss
heart discomfort
sleep problems
depression
physical and mental exhaustion
sexual problems
joint and muscular discomfort
It is important for you as the patient to understand the information regarding HRT, the risks AND the benefits. Know your risks by:
Knowing your family history of breast cancer or prostate cancer (or any cancer for that matter),cardiovascular disease. If you have a personal history of cancer, talk to your provider about HRT options that are safer for you. There is no one side fits all to hormone therapy.
Get annual check ups. This should include mammograms, PSA screenings, pap smears, cholesterol screenings, etc.
Talk to your provider about HRT: You NEED a provider who is up to date on the latest and accurate information regarding HRT. Your questions regarding HRT should not simply be dismissed. If this happens, find another provider. Your provider should talk to you about the risks vs benefits of HRT. We know that HRT is a very effective treatment for menopausal symptoms. However it is important to understand the risks and how to conduct risk stratification for women with menopausal symptoms. For women in early menopause AND without contraindications to treatment, the benefits of HRT likely outweigh the risks when used for menopausal symptom management.
It is time to get menopause symptom management back on track to help women live their best lives. Menopause SHOULD be the best time of a woman's life and not a life sentence to misery.
Dr. Akindipe, DNP, APRN, NP-C
Your partner in health
References
Chester, R., Kling, J., Manson, J. (2018). What the women's health initiative has taught us about menopausal hormone therapy. Retrieved from https://onlinelibrary.wiley.com/doi/10.1002/clc.22891
Vogel L. Trial overstated HRT risk for younger women.CMAJ. 2017;189(17):E648-E649. doi:10.1503/cmaj.1095421
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