For years, hormone replacement therapy was, and continues to be, prescribed as a treatment for women experiencing menopausal symptoms. But what relationship does this therapy have with cancer?
Link between hormone replacement therapy and cancer
Estrogen is a sex hormone found in both men and women (although in smaller amounts in men). The main source of estrogen is the ovaries in women, although the adrenal glands also produce small amounts of this hormone. It is known that having too much or too little estrogen can cause negative effects in the body.
As early as 1896, the ovaries were recognized as influencing breast cancer, as some women with breast cancer improved when their ovaries were removed. But estrogen itself wasn't discovered as a hormone.
Doctors began prescribing estrogens to women who were going through menopause or had their uterus removed to prevent menopausal symptoms, which can include hot flashes, mood swings, anxiety, and vaginal dryness.
However, today, research recognizes that " there is a causal relationship" between synthetic estrogens and the incidence of breast cancer in postmenopausal women. Let's take a closer look at why these hormones are still prescribed today and why there is still a lot of confusion about the risks.
Estrogen and hormone therapy for menopause
Menopausal hormone therapy is a form of treatment in which a patient experiencing menopausal symptoms is prescribed estrogen, which her body will stop producing once menstruation stops.
Hormone replacement therapy in menopause usually includes estrogen alone or estrogen combined with progestin, a synthetic version of progesterone, another sex hormone found in both men and women. Women with an intact uterus will generally receive the combination of the two hormones, while women without their uterus will receive estrogen alone.
So why did millions of women get this treatment without their doctor warning them about the risks, especially an increased risk of breast cancer?
Years of medical advice with no science to back it up
Although there was concern that this treatment could contribute to the development of breast cancer, many doctors believed that the benefits outweighed the risk. Therefore, for more than half a century, “multiple observation studies” were used to justify the beneficial effects of menopausal hormone therapy until a randomized clinical trial was conducted.
Women with these hormones appeared to have lower heart attack rates, and since heart disease was (and still is) the leading cause of death for women, these hormones seemed like a beneficial form of treatment overall.
However, there were other factors involved: for example, women who had access to this form of therapy also tended to be of higher socioeconomic class, meaning they not only had a healthier diet, but also had regular check-ups And they tended to participate in exercise, which would have worked to lower their risk of heart attack.
Doctors continued to prescribe estrogens without much science to back this form of treatment - that is, until a large experiment conducted called the Women's Health Initiative revealed the dangers of menopausal hormone therapy.
What the studies revealed
Hormone therapy for menopausal women is not only given to slow down the symptoms of menopause. It can also be used to control the risk of osteoporosis and heart disease later in life. But research was soon published that led millions of women to stop taking their hormonal medications.
One study was conducted in women ages 50 to 79 who had an intact uterus. These women received estrogen and progestin combined as a form of treatment, and as a result they experienced invasive breast cancer and heart disease. Based on invasive breast cancer, the trial was stopped prematurely.
The study concluded that the risks outweighed the benefits of using estrogen and progestin combined in healthy postmenopausal women.
Another study examined women without their uteri on estrogen therapy alone. These women, who spanned the same ages as the other group, saw an increased risk of stroke and blood clots, although a negligible decrease was found in incidents of breast cancer.
Before the Women's Health Initiative, estrogen was the most widely prescribed drug in the United States, with sales of $ 1 billion. In the following year, the number of prescriptions plummeted, and so did incidents of breast cancer.
Role of estrogen in patients with different hormonal needs
It is important to understand that there are different types of breast cancer and that not all are sensitive to hormones, although most (75 percent) are.
It is also essential to recognize the role of estrogen in patients with different hormonal needs. According to some research, when applied properly, hormone replacement therapy is considered beneficial.
By using hormone therapy for a limited period of time after menopause, experts insist that it has benefits, but only when used short-term and only when necessary.
Today, the role of estrogen in breast cancer remains controversial. Some research shows that women who have had their uterus removed benefit from hormone replacement therapy and have fewer heart attacks.
For years, doctors believed that the benefits of hormone replacement therapy for menopausal women outweighed the risk; With the results of the Women's Health Initiative, things seem to have changed. The problem is that patients and doctors often disagree on the appropriate use and benefits of estrogen therapy.
What you need to know today about hormone replacement therapy
This is the bottom line on menopausal hormone therapy in our modern world.
Your body is unique. Not all women who go through menopause need estrogen therapy.
Hormones are not a long-term solution. Most medical experts agree that menopausal hormone therapy should not be used long-term.
Some estrogens are made from animals. Premarin is the only hormone replacement drug for women that is produced from the urine of pregnant female horses, which may raise ethical concerns for some patients.
Don't neglect the power of diet and lifestyle. Menopause can be better controlled through diet and lifestyle changes, and pharmaceutical medications are not always needed to curb symptoms. (Also, the word symptom is often associated with a disease, and menopause is not one!)
Transgender women are also affected. Transgender women can take Premarin to induce female sexual characteristics during their physical transition. Some research shows that while taking these hormones, transgender women experience an increased risk of breast cancer.
Beware of pharmaceutical contraceptives. If you take oral contraceptives, you also have a slightly higher risk of breast cancer, as these hormones increase estrogen levels in the body.
Today, your choice to take estrogens is an individual decision that only you can make after reviewing the risks and benefits with your trusted doctor.
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