Hormone Therapy in Menopause: Will It Raise My Breast Cancer Risk?

Ask 20 different women about hormone therapy for menopause, and you’ll likely hear 20 different answers. Some will tell you it’s excellent for relieving symptoms like hot flashes and night sweats. Others will say they’ve heard it increases your risk for developing breast cancer.

So, what’s the real story? Here, Jennifer Landes, DO, a Certified Menopause Specialist with Grand View Health OB/GYN, clarifies the ongoing debate about the safety and effectiveness of hormone therapy, particularly when it comes to breast cancer risk.

Menopause is the natural process that occurs when a woman’s menstrual cycles come to an end, leading to symptoms such as sleep disturbances, vaginal dryness and hot flashes. These symptoms are caused by the decline of hormones within the body, including estrogen, progesterone and testosterone.

“During menopause, a woman’s hormone levels fluctuate on a daily basis, and there are no generally accepted ‘normal levels,’” Dr. Landes says.

Hormone therapy is a proven treatment for the relief of menopause symptoms. Most often, it includes using estrogen and progesterone together, but for some women, hormone therapy may also include using testosterone.

According to the American Cancer Society (ACS), hormone replacement is conducted in two ways:

• Systemic hormones, which may include pills, skin patches, injections or a vaginal ring that allow the prescribed hormones to enter the bloodstream.
• Topical hormones, creams which can be placed in the area that needs treatment (typically the vagina).

Typically, hormone replacement is most beneficial when it starts earlier in the menopause transition. “Most women can safely use hormones, but the ideal time to start is within 10 years of your last menstrual period,” Dr. Landes says.

“Hormone therapy can help with almost all of the most common symptoms of menopause,” Dr. Landes says. Specific benefits include:

• Reduction in menopause symptoms such as hot flashes, night sweats, sleep disturbances, vaginal dryness and painful intercourse
• Decreased rate of urinary tract infections
• Increased bone health and prevention of bone-related conditions like osteoporosis and osteopenia
• Improved protection for the heart and brain. Hormone therapy has been shown to reduce coronary heart disease by 30% – 50% according to more than 40 observational studies. Some studies also show that hormone therapy may reduce the risk for diseases that cause dementia, but other studies contradict these findings.

The controversy over hormone therapy and breast cancer risk has been ongoing for two decades. Initial results of studies from the Women’s Health Initiative (WHI) suggested that there was a higher risk of breast cancer in women using hormone therapy. However, subsequent studies have clarified this risk.

“Today, we know that hormone therapy may slightly increase the risk of breast cancer; however, the risk is relatively small,” Dr. Landes says. “For individual women, there is about a 0.08% increased risk of breast cancer per year.”

According to the ACS, to put those numbers into perspective, if 10,000 women took hormone replacement for a year, it would result in about eight more cases of breast cancer per year than had they not taken hormone therapy.

“In women who used hormone therapy and developed breast cancer, there was no increased risk of mortality from breast cancer,” Dr. Landes says. “More women die every year from heart disease than breast cancer, and hormone replacement can be protective against heart disease.”

It’s also important for women to know that hormone therapy can increase the risks of blood clots in older women and women with certain high risk factors for a heart attack.

If you’ve entered menopause and are bothered by hot flashes and other symptoms, hormone therapy is an option worth considering.

1. Talk with your healthcare provider. “Every woman is different and had her own story and risk for disease,” Dr. Landes says. “You need to discuss treatments like hormone therapy with your doctor to determine whether it’s right for you and which type may benefit you the most.”

If you want one-on-one guidance on thriving during menopause, you can schedule an appointment with Dr. Landes at Grand View Health OB/GYN locations in Quakertown, Pennsburg or Dublin. Call 215-536-3200.

If you’re worried about your risk for breast cancer, gain peace of mind by scheduling your mammogram today. Walk-in mammograms are available weekdays at Grand View Health locations in Quakertown, Pennsburg, Lansdale, Dublin and Sellersville (at Grand View Hospital). You can also schedule an appointment for a mammogram at the Harleysville or Sellersville Outpatient Centers. Call 215-453-4100.