Breast Health and Hormone Replacement Therapy

Menopause is a natural biological event, which can bring bothersome symptoms in some women and may need intervention to help optimize quality of life. Hormone replacement therapy, better known as Menopausal Hormone Therapy (MHT), are female hormones, prescribed to treat bothersome menopausal symptoms. They usually contain a combination of estrogen and progesterone or may contain estrogen alone. MHT is available as oral tablet, skin patch, gel, cream or as a spray.

The risks and benefits of MHT have long been debated and are important to understand in terms of breast health.

What is MHT used for?

MHT is the most effective way to treat menopausal symptoms of hot flashes, night sweats and vaginal discomfort. MHT has also been shown to reduce hip and vertebral fractures and prevents bone loss (osteoporosis) in postmenopausal women, although MHT is not the first line of treatment for osteoporosis. MHT, when taken early in the postmenopausal years can decrease the risk of heart disease.

What are the risks associated with MHT?

MHT has been associated with increased risk of heart attack, stroke and blood clots while a woman is on MHT, the risk returns to normal after MHT is stopped. Breast cancer, increased vaginal bleeding, urinary incontinence, and dementia (in women 65 years or older) are some other risks associated with MHT.  Estrogen alone can increase the risk of uterine cancer, therefore women with intact uterus are prescribed a combination MHT.

Further details:

The risks associated with MHT vary depending on age. MHT if started before age 60 or within 10 years of menopause, appears to be beneficial while the risks are greater in women older than 60 years of age and beyond 10-20 years from onset of menopause. MHT given as estrogen alone or as combined estrogen-progesterone affects these risk factors as well.  Your personal and family history is also a significant factor in determining your risk with MHT.

Should you take it?

The protective benefits of MHT in women with premature menopause (before age 40), who are otherwise healthy and can keep up with regular physical exams, mammograms and pap smears, usually outweighs the risk.  If you are experiencing menopausal symptoms, have bone loss and had premature menopause, MHT can be the most effective treatment for you.

“I have discovered this (menopause) is your moment to reinvent yourself after years of focusing on the needs of everyone else. It’s your opportunity to get clear about what matters to you and then to pursue that with all of your energy, time and talent” – Oprah Winfrey.

For women who reach menopause after 45, and are experiencing menopausal symptoms, lifestyle and diet changes, eating foods rich in calcium and vitamin D or taking supplements helps prevent osteoporosis. Some medications (used for treating depression and seizures) can help with hot flashes. Decreasing caffeine and alcohol intake, no smoking and practicing deep breathing techniques also helps with hot flashes. Using a vaginal moisturizer or lubricant can help with vaginal dryness and discomfort.

If a woman has history of breast/uterus/ovarian cancer, blood clots, stroke, vaginal bleeding or liver disease – it’s best to avoid MHT.

Alternative therapies for menopausal symptoms:

Relaxed deep breathing exercises, yoga, mindful meditation and acupuncture have all been shown to be quite helpful for menopausal symptoms.

Soy products, whole grain cereals, primrose oil, flaxseed, and black cohosh contain estrogen-like compound and have all been used as complimentary and alternative therapies. However, their long-term effects and interaction with other drugs a woman might be taking, are still unclear.

Bio-identical hormones are no safer than regular MHT so do consult your doctor about your specific risks and benefits before taking them.

Final words:

MHT, like most things in life, is neither all good nor all bad! Discuss with your doctor your particular risks and benefits, various treatment options and decide what is best for you. If you decide to take it – choose the right kind in the lowest possible dose, maintain a healthy lifestyle, keep in touch with your physician, and maintain regular screening for breast and pelvic health. Food and Drug Administration advises women to take MHT for the shortest time in the lowest possible dose to control menopausal symptoms. And remember to pamper yourself with good health!

“I have discovered this (menopause) is your moment to reinvent yourself after years of focusing on the needs of everyone else. It’s your opportunity to get clear about what matters to you and then to pursue that with all of your energy, time and talent” – Oprah Winfrey.