Hormone replacement therapy - HRT - is the use of oestrogen, or oestrogen +
Although HRT is the most effective treatment for hot flushes and other menopausal symptoms, studies have shown an increased risk of breast cancer, heart disease and ovarian cancer associated with the use of HRT. As a result there has been a significant fall in the number of women taking HRT. In accordance with guidelines, GPs are advised to prescribe HRT in ‘the lowest effective dose for the shortest time possible’. It is no longer prescribed as a prevenative treatment for osteoporosis or heart disease.
Women and their doctors therefore have to decide whether or not the benefits of HRT outweigh the possible increase in breast cancer risk. Menopausal women experience many physical and emotional changes, so a potential increase in breast cancer risk is not the only deciding factor. Several women we spoke with were wary of media reports about HRT and breast cancer and had discussed the pros and cons with their doctors.
Some women were taking or had been taking HRT to relieve menopausal symptoms or to protect against osteoporosis. Several praised its benefits for menopausal symptoms and recommended it to others, though some had gained weight whilst taking it. One woman who had taken HRT for ten years, said it had helped with her day and night sweats. A nurse who had used HRT for some years said that, for her, the low risk of getting breast cancer was outweighed by the benefits of taking HRT. Another woman whose mother had died of breast cancer said her GP emphasised the importance of attending for breast screening because of the risks of HRT. She stopped taking HRT for a while but felt 'miserable' off it and asked to take it again. One woman had had depression and panic attacks during her menopause, which went away with HRT. She was now scared of stopping it.
Several women had been on HRT but were no longer taking it. Some had stopped taking it when the menopause had ended. One said her consultant felt the cysts she'd had in the past might have been caused by HRT. She was no longer taking HRT and said she could live with the mild hot flushes she occasionally had. Another woman stopped taking HRT after 18 months because her blood pressure had risen. After a year on HRT, one woman tried a herbal treatment which worked just as well without causing weight gain. She preferred Wild Yam Root to HRT, which might have increased her risk of getting breast cancer, and recommended it to other women.
A few women who'd had breast cancer wondered if HRT had caused it, and one said she needed to blame her cancer on something and put it down to HRT (see Healthtalkonline - Breast Cancer website). Another wondered whether stress had played a role. One woman, who'd had an early form of breast cancer (DCIS), had stopped taking HRT for osteoporosis and wondered if this had eliminated her risk of getting DCIS again, which HRT might have caused (see 'DCIS: views on breast screening'). She had since been prescribed calcium tablets for her bones and wondered why she hadn't been prescribed these earlier as doctors knew that HRT carried a breast cancer risk.
All the women who took HRT and were later found to have breast cancer were advised to stop taking it after their diagnosis. Most did not take HRT again, but one asked to go back onto HRT because it greatly improved her quality of life, and her doctors agreed. Another, who'd had Paget's disease (a rare cancer of the nipple) and DCIS, said that she'd been prescribed HRT for five years without really being monitored until she changed GP. Her new GP suggested she come off HRT.
Some people had chosen not to take HRT, despite it being recommended by other women. One woman whose mother had had osteoporosis refused to take HRT because its long-term effects were uncertain. A few others said they would like more information about HRT and its long-term effects.
Last reviewed November 2010.
Last updated November 2010.
