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Fall 2010

Caution Urged for Women Undergoing Postmenopausal Hormone Therapy

VS-Fall10-Hormone TherapyAt one time, experts encouraged postmenopausal women to take hormone therapy (HT) not only because it reduced such symptoms as hot flashes and vaginal dryness but also because researchers believed estrogen lowered women’s risk for developing some diseases. But numerous studies published less than a decade ago contested that approach, demonstrating that HT actually increases women’s risk for developing conditions such as cardiovascular disease and breast cancer. Now experts say there is no one-size-fits-all recommendation for the use of HT in postmenopausal women.

“It’s a scenario that’s very confusing to women,” says Gail Greendale, M.D., research director of the Iris Cantor-UCLA Women’s Health Center. “After we discovered the potential risks, many women and physicians became afraid to even think about HT. But some women may be suffering unnecessarily because in some cases, appropriate, short-term, targeted use of HT in symptomatic woman can be beneficial and relatively safe.”

Some women with less severe symptoms may opt to forego treatment, while others may respond well to alternatives to HT. These include medications typically used for depression but which have been proven effective in reducing hot flashes when used at lower doses. Vaginal moisturizers, creams or pills may also provide relief for some women. But the most effective treatment, Dr. Greendale says, remains systemic HT, which includes estrogen or estrogen in combination with progesterone. Both, however, have potentially serious side effects.

“There is some controversy about how we use these medications,” explains Sara Hurvitz, M.D., a breast oncologist at UCLA. “With regard to risk for breast cancer, using estrogen alone is considered safer than using estrogen in combination with progesterone. But if you use estrogen alone in a woman who still has her uterus, her risk for uterine cancer rises.”

Balancing the risks and benefits of HT represents a major challenge for healthy postmenopausal, and even peri-menopausal, women. But these challenges are even greater for some women facing breast cancer, according to Dr. Hurvitz. “The tumor is hungry for estrogen in women who have estrogen and/or progesterone receptors expressed in their breast cancer,” she says. “We want to interrupt the feeding process in order to stop the growth of cancer cells. Therefore, the use of anti-estrogen therapies, or hormone-modulation therapy, is almost always recommended in patients with breast cancer whose tumors express hormone receptors.”

Drs. Hurvitz and Greendale agree that a tailored approach, in consultation with a woman’s physician, is necessary when considering therapies. “The essential approach to HT is that it should be reserved for symptomatic women and used in the lowest dose and for the shortest period of time to effectively control symptoms,” Dr. Greendale says. “That is the most conservative and safest way to use the hormone,” Dr. Hurvitz adds.

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