The reason they took you off HRT after 10 years is that it doubles the risk of you getting breast cancer.
What has medical research found out about the risks and benefits of hormone use after menopause?
The most comprehensive evidence about the risks and benefits of taking hormones after menopause to prevent disease comes from the Women?s Health Initiative (WHI) Hormone Program, which was sponsored by the National Heart, Lung, and Blood Institute (NHLBI) and the National Cancer Institute (NCI), parts of the National Institutes of Health (NIH). This research program examined the effects of menopausal hormones on women?s health. The WHI Hormone Program involved two studies?the use of estrogen plus progestin for women with a uterus (the Estrogen-plus-Progestin Study), and the use of estrogen alone for women without a uterus (the Estrogen-Alone Study). In both hormone therapy studies, women were randomly assigned to receive either the hormone medication being studied or the placebo.
The WHI Estrogen-plus-Progestin Study was stopped in July 2002, when investigators reported that the overall risks of estrogen plus progestin, specifically Prempro?, outweighed the benefits (1).
The researchers found that use of this estrogen-plus-progestin pill increased the risk of breast cancer, heart disease, stroke, blood clots, and urinary incontinence. However, the risk of colorectal cancer and hip fractures was lower among women using estrogen plus progestin than among those taking the placebo (1). In addition, the WHI Memory Study showed that estrogen plus progestin doubled the risk for developing dementia (a decline in mental ability in which the patient can no longer function independently on a day-to-day basis) in postmenopausal women age 65 and older. The risk increased for all types of dementia, including Alzheimer?s disease (2).
The WHI Estrogen-Alone Study, which involved Premarin?, was stopped in February 2004, when the researchers concluded that estrogen alone increased the risk of stroke and blood clots. In contrast with the WHI Estrogen-plus-Progestin Study, the risk of breast cancer was decreased in women using estrogen alone compared with those taking the placebo (see Question 5). Use of estrogen alone did not increase or decrease the risk of colorectal cancer (3). Similar to the results seen in the Estrogen-plus-Progestin Study, women using estrogen alone had an increased risk of urinary incontinence and a decreased risk of hip fractures.
Another large epidemiologic study, the Million Women Study, enrolled 1.3 million women in the United Kingdom. This study evaluated health outcomes in women using and not using menopausal hormones. Several analyses have been published to date, and many more are expected in the future (4, 5, 6).
How does menopausal hormone use affect breast cancer risk and survival?
The WHI Estrogen-plus-Progestin Study
concluded that estrogen plus progestin increases the risk of invasive breast cancer. After 5 years of follow-up, women taking these hormones had a 24 percent increase in breast cancer risk compared with women taking the placebo. The increase amounted to an additional 8 cases of breast cancer for every 10,000 women taking estrogen plus progestin for 1 year compared with 10,000 women taking the placebo (7).
A detailed analysis of data from the WHI Estrogen-plus-Progestin Study showed that, among women taking estrogen plus progestin,
the breast cancers were slightly larger and diagnosed at more advanced stages compared with breast cancers in women taking the placebo. Among women taking estrogen plus progestin, 25.4 percent of the cancers had spread outside the breast to nearby organs or lymph nodes compared with 16.0 percent among nonusers. Women taking estrogen plus progestin also had more abnormal mammograms (breast x-rays that require additional evaluation) than the women taking the placebo (7).
The WHI Estrogen-Alone Study concluded that taking estrogen did not increase the risk of breast cancer in women with a prior hysterectomy, at least for the 7 years of follow-up in the study. Further analysis of data from the study indicated a 20 percent decrease in risk of breast cancer in women taking estrogen alone, although this decrease was seen mainly in the occurrence of early-stage breast cancer and ductal breast cancer (a specific type that begins in the lining of the milk ducts in the breast) (8). The observed reduction amounted to 6 fewer cases of breast cancer for every 10,000 women taking estrogen for 1 year compared with 10,000 nonusers, but this lower incidence was not statistically significant; i.e., the lower incidence could have arisen by chance rather than being related to estrogen-alone use (8). The Estrogen-Alone Study also showed a substantial increase in the frequency of abnormal mammograms (8).
A comprehensive review of data from 51 epidemiological (population) studies published in the 1980s and 1990s found a statistically significant increase in breast cancer risk among current or recent users of any hormone replacement therapy compared with the risk among nonusers. Most women in the analysis (88 percent) had used estrogen alone, and data for estrogen-plus-progestin users was not analyzed separately. Analysis of the pooled data also showed that the risk of breast cancer increased with increasing duration of hormone use, and this effect was more prominent in women with low body weight or a low body mass index. However, breast cancers in hormone users were less likely to have spread to other parts of the body compared with the breast cancers in nonusers. The increase in breast cancer risk largely, if not completely, disappeared about 5 years after cessation of hormone use (9).
As part of the Million Women Study, researchers examined six types of breast cancer among users and nonusers of menopausal hormones. The results showed that the effects of hormone use varied among breast cancer types. Overall, breast cancer risk was significantly increased among current users, although the risk was lower among women with higher body mass index (5).
From
National Cancer Institute
My partner is waiting for the test results to come back to see if she is menopausal. After the Dr took the blood he said he would prescribe her HRT there and then, but only for 5 years due to the reasons above. She declined as she wanted to find out more about HRT, and also wait for the results. She has decided to not to have HRT as her mum and aunt both had breast cancer and died, so she is susceptible to it, so she doesn't want to take anything that might encourage any breast cancer to grow. Also a friend's mum had ovarian cancer, then she got breast cancer which spread to her bones and brain and also sent clots to her leg so that turned gangrenous, she died 2 days later, and she was also taking HRT.
