HRT: Know the risks and the alternatives

Hormone replacement therapy (HRT) has been a bone of contention with menopausal women all over the world for years.

As we have discussed in previous e-alerts, hormone replacement therapy can put women at risk of developing a number of life-threatening conditions.

Now the US National Cancer Institute (NCI) reports the results of a research study with conclusions that I hope will prompt every woman taking oestrogen to reassess her treatment.

HRT increases risk of ovarian and breast cancer
The NCI study researched existing data from the Breast Cancer Detection Demonstration Project, a screening programme that examined a total of 44,241 post-menopausal women in 29 clinical centres in the US, from 1979 through 1998. The NCI team designed its study to glean information that might associate HRT with ovarian cancer - an association that had previously been unclear.

Their conclusion was troubling, to say the least. They found that post-menopausal women who take oestrogen for 10 years or more may have a full 60% higher risk of developing ovarian cancer than women who never use HRT. In addition, they believe that the longer a woman uses oestrogen, the more likely she is to develop ovarian cancer.

On what should have been something of a bright note, the researchers also concluded that women who use a combination of oestrogen and progestogen do not have a significantly elevated risk of developing ovarian cancer. But at best this could only be considered cold comfort in the wake of the news that the US Women's Health Initiative study concluded that that same mix sharply increases the risk of breast cancer.

In the e-alert HRT: Are we now trading hot flushes for strokes? (15/3/04) we told you how previous studies also pointed out the harmful health effects of HRT on women.

* A 2003 study showed that combined HRT increased the risk of developing Alzheimer's disease and other forms of dementia.
* A University of Rochester study reported in 2004 that women who took HRT suffered from impaired hearing.
* A study in 2004 from Brigham and Women's Hospital showed a sharply increased risk of asthma for women taking either oestrogen alone or combined HRT.

But wait theres more.

A study conducted by the University of East Anglia in Norwich, in the e-alert Another reason to question HRT (20/6/03), concluded that women using HRT may be as much as three times more likely to develop gallstones.

Increased risk of breast cancer, ovarian cancer, Alzheimers disease, hearing loss and asthma?

Suddenly, it seems that everywhere an oestrogen user turns she's hemmed in on all sides with disappointing news. Fortunately for these women there are choices.

The personal decision
As I have often said before, the question of whether or not to use HRT is a very personal decision. I haven't experienced the menopause yet myself, but many women in my life have, so I know it's not easy.

My cousin Emily, for instance, uses oestrogen to manage hot flushes and other menopausal conditions. Emily is an educated, health-conscious individual, so she does not choose oestrogen therapy lightly. Faced with the choice of enduring a condition that creates considerable discomfort and anxiety each and every day, or of taking a medication that will control the condition while creating a long-range anxiety in the possibility of developing cancer, she has made a hard decision.

And as with so many like her, Emily hopes to discontinue HRT within a year or two, hoping also that she won't have exposed herself to enough oestrogen to develop cancer. She doesn't like this situation, but she's decided to take her chances, and, while I'm concerned about her health, I respect her right to make that decision for herself.

With the research stacking up against HRT, hard decisions are in order for the millions of women who are experiencing the daunting difficulties of the menopause. Some, like Emily, will decide to take a chance with one of the hormone replacement therapies. Others may be fortunate enough to be able to control their conditions with natural alternatives: using herbal remedies, for instance, such as dong quai, black cohosh, liquorice, red clover and chaste berry. Nutritional supplements of vitamins A, C and B complex, plus minerals like boron may also be effective. In addition, some women may find relief in yoga, acupuncture or special exercise regimens.

The important thing for women to know is that there are a number of ways they can cope with menopause naturally. They don't work for all women, but these alternatives should be given a second look now that we know the choice of oestrogen may have even more dire consequences than we had previously suspected.