Menopause and Breast Cancer: Is It Safe to Use Hormone Replacement Therapy?

Open up Google, type in “Menopause and,” and see the results. You’ll probably see these phrases populate your search bar: menopause and night sweats, menopause and insomnia, menopause and breast cancer, menopause and breast pain, menopause and anxiety, menopause and hair loss. With all of these “ailments,” where’s the menopause and treatments option? Where is the information on specific treatments like hormone replacement therapy (HRT)? Yes, Google, we are all experiencing hot flashes, night sweats, and irregular periods. We don’t need a search engine to remind us what we’re already experiencing, we need some relief! Throw us a bone (or a towel to wipe off the hot-flash sweat). Trying to research and figure out treatments during menopause can feel more futile than trying to get your kid to bed after they’ve eaten half a pillowcase full of Halloween candy.

What’s the Deal With Treatment Options During Menopause?

Remember that game of telephone? The one where you’d sit in a circle and whisper a word in the person’s ear sitting next to you, then, that person would repeat your word, again in a whisper, to the person on their right, and so on and so on until the last person said the word aloud. The goal was for the last person to say the exact word the first person said. But, how often did that happen? Between the giggles, kids not being able to hear, and that one kid who wanted to deliberately screw up the end result, it was rare, if not impossible, to accomplish the game’s goal.

That game is a bit like menopause treatments. Professionals create solutions for menopausal maladies, products go through stringent testing before arriving on pharmacy shelves, and people start talking about the solution’s advantages and disadvantages. Take, as one example, menopause and breast cancer. Hormone replacement therapy came onto the market as a way to make up for the life-altering shifts caused by fluctuating and decreasing levels of estrogen, progesterone, and testosterone. But, one person read that the study posed risks of breast cancer and a game similar to telephone began. Soon enough, HRT for menopause got as bad a reputation as that kid you tried to kick out of your telephone game. But, what are the facts? Does HRT cause breast cancer? Or, is it safe to use hormone replacement therapy to treat your menopause signs and symptoms?

Why Is Hormone Replacement Therapy (HRT) Used During Menopause?

You’ve probably heard that being in the perimenopause-to-menopause transition is synonymous with all sorts of changes, like the inevitable-but-ever-exciting mood swings. Maybe, that’s the reason your partner complains about your moody days before your red tide rolls in. (Sure, Derek, I may be a bit moody, but it’s nothing compared to how you get when you come in last in your Fantasy Football league.) During the transition, your hormones (specifically estrogen and progesterone) will feel like they are skydiving … one minute they are sky-high and the next they are plummeting downward, screaming and kicking, barely remembering to pull the rip-chord of your sanity. In more gentle terms, during the months and years leading up to menopause, estrogen and progesterone levels start to decline.

Throughout the body, receptors (cells that respond to stimulus and send a signal to your nerves) are available for both estrogen and progesterone. When levels start to decline, every system in the body with these hormone receptors detect the change. Then, when the brain takes notice—just like a pre-teen at a brand new middle school—it often has a difficult time adjusting.

When the hormonal changes are small, the adjustments are easy. But, the big adjustments create some serious biological drama. We’re talking mood swings, anxiety, and depression, oh my! I recommend you start a collection of adorable throw pillows. Not because they’re cute and provide additional back support, but because they’re great to scream into and thus provide additional emotional support!

To prevent your moods and other menopause symptoms from interfering with what otherwise could be a remarkable midlife, hormone replacement therapy landed on pharmacy shelves in the 1960s in the USA. HRT is a treatment approach that, as the name suggests, replaces the hormones that the female body refuses to produce properly after menopause.

Why Is Hormone Replacement Therapy Controversial?

Did you know that HRT is a hot topic in the menopausal world? According to BreastCancer.org, “In 2002, a study found a link between HRT and an increase in breast cancer risk, which caused a number of women to stop taking HRT.” This finding has caused menopausal people to ask, “Is taking hormone replacement therapy to treat menopause’s many symptoms really worth the gamble?”

Is It Safe to Use Hormone Replacement Therapy?

A study conducted by the Women’s Health Initiative stated that the risk of the drug may differ for every person depending on the type, dose, and duration of use. To support that statement, I’m throwing it back to our pals at BreastCancer.org, “In June 2017, the North American Menopause Society updated its guidelines on using HRT. The guidelines say that for women younger than 60 or within 10 years of menopause who have no other contraindications (medical reasons to avoid HRT), the benefits of HRT outweigh the risks when treating menopausal symptoms, especially hot flashes, and for women who have a higher-than-average risk of bone loss or breaking a bone. It is extremely important to know that being diagnosed with breast cancer is a contraindication for HRT. Women who have a history of breast cancer should not take HRT.”

How To Know When to Start HRT

If your menopausal signs and symptoms are interfering with your daily life, you are younger than 60, are within 10 years of menopause, have no other contraindications, do not have a history of breast cancer, do not currently have breast cancer, and you consult first with your doctor and they clear you, you are A-OK to go on hormone replacement therapy for menopause.

Types of HRT

Why should you take hormone replacement therapy if it only replaces your fluctuating, decreased, or non-existent hormones? Is it really that important? HRT, by replacing your hormones, regulates the parts that your female sex hormones used to do when they were balanced and operating at full capacity, such as preventing your down-there regions from feeling dryer than a sponge left outside in an Arizona summer. It’s a domino effect: proper amounts of hormones lead to fewer or resolved menopausal symptoms, which results in less problems and a healthier you.

As mentioned, HRT comes in two types and requires a doctor’s prescription:

Combination HRT contains the hormones estrogen and progestin; progestin is the synthetic type of progesterone.
Estrogen-only HRT, from the name itself, contains only the hormone estrogen.

Side Effects of Hormone Replacement Therapy

The Women’s Health Initiative (WHI) on the Increasing Risk of Breast Cancer

A clinical trial conducted by the experts may indicate that hormone replacement therapy is really something, right? Well, you are correct. After the boom of HRT in the USA in the late 1990s, the Women’s Health Initiative (WHI) studied the aftermath of this drug to its users. It was the same year when a 15-year long study was conducted by the WHI to see the connection of the following diseases to ingesting HRT for the post-menopausal symptoms.

Breast cancer
Endometrial cancer or cancer of the uterus
Cardiovascular diseases

This 15-year study became one of the largest prevention studies in the United States, as it had more than 160,000 women ranging from 50 to 79 years old as participants. The study divided the participants into two groups: (1) the combination HRT group and (2) the estrogen-only group.

In 2002, HRT usage dropped—the same year when the initial results regarding the adverse effects of HRT were released to the public.

As a safety reminder, the following data may seem to be a lot for you, but do not be intimidated as it is important for you to know. Always remember that knowledge is power.

Hold up! Just a side note before diving deeper to the risk of breast cancer due to HRT … What do you think is the cause of breast cancer? From radiation to this therapy, there are many causes of cancer. As the Breast Cancer Org explains it, “the hormones in HRT can cause hormone-receptor-positive breast cancers to develop and grow.” HRT may either heighten the risk or trigger existing cancer cells inside your body.

Alright, back to the prevention study. Women in the combination HRT group had increased breast cancer risk by 75%. This occurred even if the participants had HRT only for a short period of time. The risk increased as the dose of the HRT increased. In other words, women who took lower doses had lower risk of breast cancer compared to those who took higher doses. Although the same women showed positive results when it came to bone fracture and osteoporosis, these findings on increased breast cancer risk indeed caused the use of HRT to drop drastically. Findings from 2003 showed that the breast cancer threat declined due to the drastic drop of HRT users.

The other group of women in the estrogen-only HRT also had increased risk of breast cancer. The effect of this type of HRT was found to manifest only if used for more than 10 years. Nonetheless, there was some data that showed increased risk of endometrial cancer due to estrogen inducing the uterus lining to thicken.

More Than a Decade After the Findings

After 13 years, the WHI released an analysis regarding their past studies. They said that the effect of HRT on breast cancer risk changes as the time passes.

Women who stop taking combination HRT lower their breast cancer risk 3 years after their last therapy. Their risk for this cancer will never go back the same as before taking the therapy.
On the other hand, women who took the estrogen-only HRT will less likely be diagnosed with breast cancer compared to those who chose not to take the therapy. This result will only manifest years after discontinuing HRT.

Will I Get Breast Cancer If I Take HRT?

Wondering if hormone therapy causes breast cancer? Studies are all over the place in terms of whether or not HRT increases your risk. Even though the WHI found that estrogen-only hormone replacement therapy reduced breast cancer risk, a number of other studies have found that both types of HRT did in fact increase breast cancer risk. There’s no clear answer at this point in time as to whether or not HRT increases the risk of breast cancer.

Side note: Since we are talking about cancer and the risk of getting it, I do want to mention (bummer alert) that the risk of getting cancer does increase with age naturally. According to the National Cancer Institute (NCI), the median patient age at the time of a cancer diagnosis is 66. “Advancing age is the most important risk factor for cancer overall,” the NCI website says.

From night sweats to achy joints, menopausal symptoms can be debilitating for some people. If this is you, then by all means talk to your doctor about treatment options. Ask your healthcare provider how you can treat your symptoms while reducing your risk of breast cancer. Also, be sure to discuss the pros and cons of the different types of HRT and doses.

It’s a Wrap!

In a nutshell, hormone replacement therapy has its fair share of pros and cons. It’s not any different from the pharmaceutical commercials you see where they rattle off a list of side effects at warp speed, after showing you individuals who seem completely happy and clearly aren’t experiencing any of those side effects on camera. Yes, HRT can help balance out those ever fluctuating hormones during the menopausal transition and help make the symptoms somewhat bearable. However, studies are all over the place in terms of whether or not HRT increases the risk of breast cancer.

If you are severely bothered by the symptoms of the menopause, then HRT might come in handy. However, speaking friend to friend here, if you are unsure or your gut doesn’t feel good about something that concerns your health, you need to make an appointment to speak with your healthcare provider and discuss all of your options and concerns. Create a plan that works for you and makes you feel good about yourself and your decisions. You have options!

Sources

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