According to a recent article published in the

Journal of the National Cancer Institute, women treated with some forms of hormone replacement therapy may be at a higher risk for ovarian cancer.

Hormone replacement therapy (HRT) is typically prescribed for women during menopause. Menopause is a natural phase of maturing womanhood, during which 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. Despite these benefits, however, some clinical studies suggest that HRT use, particularly for extended periods of time, may increase the risk of developing breast cancer and uterine cancer.

HRT includes estrogen and may be combined with progestins, a female hormone that, among other roles, induces shedding of the uterine lining during menstruation. Progestins are added to HRT to reduce the risk of the development of uterine cancer that occurs with the use of estrogen alone. Progestins can be added to estrogen on a continual or sequential basis.

Researchers from Sweden recently conducted a clinical study involving over 4,000 women to determine if there was an association between ovarian cancer and HRT. Patients who received HRT that included continuous progestins had no difference in rates of ovarian cancer compared to patients who had never received any form of HRT. However, patients who received only estrogen had a 43% increased risk of developing ovarian cancer and patients who received HRT with sequential progestins had a 54% increased risk of developing ovarian cancer compared to patients who had never received any form of HRT.

These results indicate that patients treated with HRT consisting of only estrogen or estrogen plus sequential progestins may be at an increased risk for developing ovarian cancer. However, the researchers conducting this study state that it is important to keep in mind that although the risk percentages seem high, the actual risk is no greater than two or three in 1,000 patients. In addition, HRT appears to reduce the risk of heart disease and osteoporosis in menopausal women. It is important for menopausal women to discuss the overall risks and benefits of HRT with their physician. Patients on HRT may wish to discuss screening efforts for ovarian cancer to detect it early when it is most treatable. (Riman T, Dickman P, Nilsson S, et al. Hormone replacement therapy and the risk of invasive epithelial ovarian cancer in Swedish women. Journal of the National Cancer Institute. 2002:94;497-504)

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