Hormone Replacement Therapy: What Now?
Feb. 9, 2000 -- Sixteen years ago, Kathryn Shea's body suddenly went haywire. At night, the San Francisco schoolteacher found herself tossing and turning. Once she finally fell asleep, she'd wake often, clammy with sweat. Her fitful nights left her foggy-headed and headachy in the morning. Worst of all were the moments when she'd be standing talking with someone and, in an instant, her face would turn unbearably hot and she'd break out in a sweat.
Though Shea was only 40, it turned out that she was going through menopause, suffering the vexing symptoms that befall many women as their bodies' production of female hormones slows and finally stops. Once she and her doctor realized what was happening, they tried several therapies, with mixed success. "I experimented with everything I could experiment with," Shea says.
Finally, Shea's doctor put her on a mix of the hormones estrogen and progestin (a form of progesterone). At last, Shea slept soundly at night and sailed through her days undisturbed by hot flashes. Though she started the regimen to quell her menopausal symptoms, she's still taking it today because of its bone-strengthening and heart-protecting effects.
Shea is among an estimated 16 million women taking hormone replacement therapy (HRT), according to the North America Menopause Society. The estrogen/progestin mix that brought relief to Shea has grown increasingly popular; taking estrogen alone raises a woman's risk of uterine cancer, but adding progestin greatly reduces this untoward effect.
A Precarious Position
Unfortunately, a new study published last week in the January 26 issue of the Journal of the American Medical Association has found that estrogen/progestin therapy comes with a price of its own: It increases the risk of breast cancer. Following more than 46,000 women over 15 years, National Cancer Institute researchers found that women who took the hormone combination were 20% more likely to develop breast cancer than women on estrogen therapy alone, and 40% more likely than women taking no hormones at all. The longer a woman took hormones, the greater the chance of breast cancer. While this study is not the first to find that the combination therapy increases breast cancer risk, it's by far the largest. And experts are taking the results very seriously.
So what's a woman to do? Is it time to toss progestin altogether?
That would be unreasonable, said Meir Stampfer, MD, professor of epidemiology and nutrition at the Harvard School of Public Health, and co-author of an editorial accompanying the study. He points out that progestin was added to the mix for very good reasons; without it, breast cancer risk would lessen, but the risk of uterine cancer would rise.
A Very Personal Decision
Instead, experts say, the new finding makes it more crucial than ever for women to look closely at their own family history, lifestyle, risk of particular diseases -- and deepest fears -- when making the hormone decision. Depending on how those factors stack up, women might come to very different decisions about hormone therapy -- all of them acceptable.