Menopausal hormones: definitive evidence for breast cancer

For some women, menopause is an easy life transition, but for others, it means sleepless nights, hot flushes, and often a decline in wellbeing. For decades, women have been prescribed synthetic versions of the hormones that are lost with ovarian functional decline, in pill form or in other formulations (eg, patches, gels, or injections), either as oestrogen alone (usually for women who have had a hysterectomy) or as an oestrogen and progesterone combination (usually for those with an intact uterus) to help mitigate some of the symptoms. Prescribing fell after the publicity stemming from the Women’s Health Initiative (WHI) trial reports in 2002, and 2004, which showed an increase in the risk of breast cancer with the use of combination therapy (oestrogen and progesterone). Oestrogen alone had no observed effect. The decline in menopausal hormone therapy (MHT) use was followed by a decline in the incidence of breast cancer (fear of breast cancer likely had the greatest effect on the use of hormone replacement therapy [HRT], but to my knowledge this has not been formally established). Perhaps breast cancer worry has deprived millions of women of an effective remedy for some of the symptoms of menopause. It is important to know the cancer risks with accuracy if women are suffering the consequences of avoiding MHT, and possibly, raising the risk of osteoporosis and other conditions, such as cardiovascular health or cognitive decline.

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