According to a recent article published in the Journal of the American Medical Association, hormone replacement therapy (HRT) consisting of estrogen alone does not significantly affect the incidence of breast cancer. However, the risk of stroke with the use of estrogen-only HRT is significantly increased and the Women’s Health Initiative Steering Committee has recommended that HRT should not be used to prevent chronic illness.

Hormone replacement therapy (HRT) is often prescribed for women during menopause. Menopause is a natural phase of maturing womanhood, during which the ovaries produce significantly less estrogen, ovulation ceases and menstruation ends. For many women, menopause has uncomfortable side effects. Hot flashes, sleep disturbances, depression, mood swings and anxiety may affect the menopausal woman. Additionally, menopause may also be accompanied by increased urinary tract infections, incontinence, vaginal discomfort due to a lack of estrogen-based lubrication and decreased bone density. HRT has been effectively used to mitigate these side effects and is widely prescribed for women experiencing these unpleasant symptoms of menopause. Recent results from several clinical studies have demonstrated a correlation between the use of hormone therapy and the development of breast cancer, as well as an increase from death caused by breast cancer. HRT can contain estrogen alone, progesterone alone or a combination of the two hormones. Research continues in order to answers questions regarding different outcomes for patients who use specific combinations or single-agent HRT as well as duration of use.

The Women’s Health Initiative (WHI) study was a large study involving thousands of postmenopausal women to evaluate the effects of HRT. One component of the WHI included women who received estrogen-only HRT. These women were compared to women who received placebo (inactive substitute)- (a second component of the WHI that evaluated estrogen plus progestin HRT was halted in 2002 due to the increase in health risks with HRT compared to placebo). The estrogen-only HRT component of WHI included over 10,000 women who were aged 50 to 79 years who had a prior hysterectomy (surgical removal of the uterus). After nearly 7 years of follow-up, this component was halted due to the increase in the risk of stroke by nearly 40% for patients treated with estrogen-only HRT compared to those who received placebo. However, the risk of coronary heart disease and bone fractures was decreased in the group of women treated with estrogen-only HRT compared to placebo. The incidence of breast cancer was not significantly different in either group of women.

The researchers and the WHI Steering Committee concluded that HRT should not be used as a means to prevent chronic illness. They stated that other medical means have been found to be effective at reducing or preventing heart disease and fractures that are not associated with an increase in other health risks appeared to be caused by HRT. In addition, the Food and Drug Administration recommends that estrogen-only HRT should only be used for menopausal symptoms at the lowest dose and for the shortest duration of time necessary. Postmenopausal women considering HRT should speak with their physician about their individual risks and benefits of HRT.

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Reference: The Women’s Health Initiative Steering Committee. Effects of conjugated equine estrogen in postmenopausal women with hysterectomy. The Women’s Health Initiative Randomized Controlled Trial. Journal of the American Medical Association. 2004;291:1701-1712.

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