Estrogen Okay for Some

There’s good news tonight for some women who want to use estrogen during and after the menopause. In those women have had their uterus’ removed, but only in these women, it appears----even after seven years of treatment with estrogen—using this hormone replacement treatment will not raise one’s risk of breast cancer, a commonly held concern. So, if an apple a day keeps the doctor away, hormone replacement threapy was, perhaps, one treatment that turned out to be a bad apple. Until July of 2002, hormone replacement therapy--estrogen or estrogen and progesterone together--was the standard treatment for treating problems associated with the menopause. These include symptoms such as hot flashes, night sweats, difficulty sleeping and mood changes, and forgetfulness, to preventing other diseases including osteoporosis and related fractures.

At the age of 45, Helen Stein started having many of those symptoms. She began hormone replacement therapy. “It wasn’t a tough decision 14 years ago. I’m sure it’s much tougher now,” Helen believes. It is, given the research over the past three years.

A major study--the women’s health initiative--identified health risks including an increased risk of stroke with estrogen alone in those who have had a hysterectomy. And combination treatment of estrogen and progesterone showed an increased risk of breast cancer. So the therapy was gradually abandoned. But the latest research finds either no risk, or, even perhaps a reduced risk of breast cancer in those women on estrogen alone.

Dr. Jennifer Wu, an OB-GYN at Lenox Hill Hospital, says, “This was not significant so I wouldn’t recommend estrogen as a means of decreasing your risk of breast cancer, but I think the results do provide some reassurance for patients who do rely on estrogen to maintain their quality of life.” Now, most of the women in the largest studies have been white, and few studies have looked at the risks specifically in black women.

Another study just released in the archives of internal medicine fills in the blanks regarding black women. “Women on estrogen and progesterone were at an increased risk for breast cancer. There was not a significant increased risk for breast cancer in women on estrogen alone,” says Dr. Wu. The association between hormone use and breast cancer was strongest for women who were lean. And the longer a woman took hormones, the more likely she was to develop breast cancer.

Still, the overall message is, each woman has to decide whether to use hormone replacement therapy herself--with her doctor. Helen says, “I would probably take the risk just to see if I could possibly feel better.” “If a patient is properly counseled, and understands all these risks and benefits, she can make an informed decision about her healthcare,” instructs Dr. Wu.

The researchers found there were fewer breast cancers in women with localized disease who were taking estrogen, compared to those on placebo. The risk for advanced cancer was the same. Here’s another risk, though: estrogen therapy alone may increase the risk of venous blood clots, among postmenopausal women who have had their uterus removed, according to another study in the archives of internal medicine.