Alternatives To Hrt For Protecting Your Bones From Osteoporosis
HRT is no longer recommended for treatment of osteoporosis due to its risks and available alternative options. Bisphosphonate medications are generally recommended to treat osteoporosis instead. Other medications that may be considered are teriparatide, denosumab, or selective estrogen receptor modulators . SERMs are a newer class of drugs, similar to estrogen, that protect against osteoporosis by increasing bone density, while also protecting against the development of breast cancer.
Evista is a widely used SERM that has been shown to increase bone growth and density and reduce the risk of breast cancer. Unfortunately, it does not relieve symptoms of menopause such as hot flashes and may actually worsen them. It is primarily used in women who are at high risk for developing breast cancer or for those who cannot tolerate other medications used to treat osteoporosis.
Additional steps you can take to prevent and/or treat osteoporosis include:
- Performing weight-bearing exercises
Possible Side Effects Of Ais
The most common side effects of AIs are:
- Bone and joint pain
AIs tend to have side effects different from tamoxifen. They dont cause uterine cancers and very rarely cause blood clots. They can, however, cause muscle pain and joint stiffness and/or pain. The joint pain may be similar to a feeling of having arthritis in many different joints at one time. Options for treating this side effect include, stopping the AI and then switching to a different AI, taking a medicine called duloxetine , or routine exercise with nonsteroidal anti-inflammatory drugs . But the muscle and joint pain has led some women to stop treatment. If this happens, most doctors recommend using tamoxifen to complete 5 to 10 years of hormone treatment.
Because AIs drastically lower the estrogen level in women after menopause, they can also cause bone thinning, sometimes leading to osteoporosis and even fractures. If you are taking an AI, your bone density may be tested regularly and you may also be given bisphosphonates or denosumab , to strengthen your bones.
Hrt And Breast Cancer
Breast cancer is the most frequently diagnosed cancer and is the leading cause of cancer-related death in women. It affects up to one of eight women who survive up to the age of 85 years in Western countries. The disease reaches a peak of incidence in the 5059 years age range .
The WHI study results suggested a breast cancer increase in HRT users , but no data about mortality were reported because of a short follow-up period . This risk, in absolute terms, corresponds to 9 additional breast cancers per 10,000 women using estrogen-progestin therapy for five or more years . Breast cancer increase in HRT users had already been observed 20 years before, in 1997, in the Collaborative Group Study this review of 50 observational studies evidenced a relative risk of 1.35 for women who had used HRT for five years or longer. No significant excess of breast cancer had been seen five or more years after cessation of HRT use or in relation to the duration of use .
The North American Menopause Society position statement of 2017 asserts that different types of estrogen or progestogen, as well as different formulations, doses, durations, times of initiation, and patient characteristics, may play a role in HRTs effects on breast tissue. Other risk factors need to be also considered in prescribing HRT, such as BMI, cardiovascular diseases, and lifestyle factors including smoke, physical activity, and alcohol intake.
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What Are The Risks Of Hormone Replacement Therapy
But combined treatment causes the greatest increase in risk of breast cancer. So, its important to talk to your doctor about the benefits and risks of HRT for you. Tibolone, another medication that can help with uncomfortable menopausal symptoms, has also been found to increase the risk of womb cancer.
Is there an increase in ovarian cancer if you stop taking HRT?
Its thought that if there is any increase in cases of ovarian cancer among women taking HRT, the increase is very small. A recent study found that for every 1,000 women taking HRT for 5 years, there will be 1 extra case of ovarian cancer. Any increased risk of ovarian cancer is thought to decrease once you stop taking HRT.
Can You Stay On Hrt For Life
Theres no limit on how long you can take HRT, but talk to a GP about how long they recommend you take the treatment. Most women stop taking it once their menopausal symptoms pass, which is usually after a few years.
Does HRT change your face?
Overall, you may gain or lose weight once you begin hormone therapy, depending on your diet, lifestyle, genetics and muscle mass. Your eyes and face will begin to develop a more feminine appearance as the fat under the skin increases and shifts.
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Why Estrogen Does Not Cause Breast Cancer
Estrogen therapy is a vital part of hormone replacement for women in menopause and beyond. Unfortunately, conventional wisdom of the past has tied it negatively to breast cancer. With over 2 million breast cancer survivors in the U.S., there has been enormous debate surrounding using hormone replacement therapy during and after breast cancer treatment.
Should there be concern? Does estrogen actually cause breast cancer? What is the research telling us? Were here to answer these questions, debunk some myths, and find the truth.
You May Be Interested To Read
A large-scale study of HRT and the risk of breast cancer: Million Women Study Collaborators. Breast cancer and hormone-replacement therapy in the Million Women Study. The Lancet 2003 362:9382
Menopause: diagnosis and management – National Institute for Health and Care Excellence guidance on diagnosing and managing menopause.
HRT and breast cancer risk: a blog post from the ICR discussing what research about HRT and breast cancer means for women.
Further information on the Breast Cancer Now Generations Study.
Funding: This work is partially funded by the NIHR School for Primary Care Research and by Cancer Research UK through its Oxford Centre.
Conflicts of Interest: The study authors declare no conflicts of interest.
Disclaimer: NIHR Alerts are not a substitute for professional medical advice. They provide information about research which is funded or supported by the NIHR. Please note that views expressed in NIHR Alerts are those of the author and reviewer and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.
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Patient And Public Involvement
This epidemiological study investigated a research question recommended by a National Institute for Health and Care Excellence committee, which included lay members.5 It used routinely collected data and appropriate statistical techniques. The grant application process and the publication process of The BMJ both had lay involvement. No other lay people were involved in setting or extending the research question or the outcome measures in our study, nor were they involved in developing plans for the design or implementation of the study. However, to better understand motivations for starting HRT and possible adherence issues related to prescribed treatment, formal and informal conversations with some women taking HRT were also organised. In these, women generally reported high levels of adherence, regardless of whether they had sought treatment themselves or were recommended it by a doctor. Some of the women involved have also agreed to help further with interpretation and dissemination of the results through womens menopausal forums.
Hrt And Ovarian Cancer
Histologically, surface epithelialstromal tumours are the most common neoplasms of the ovary. They derive from the ovarian surface epithelium or its derivatives and occur in women of reproductive age and beyond. They are histologically composed of one or more distinctive type of epithelium, admixed with a variable amount of stroma. Their biological behaviour varies with histological type.
Because 5060% of non-mucinous ovarian carcinomas have estrogen receptors , a relationship between HRT and occurrence of ovarian carcinoma is possible in principle . A recent review of 20 pertinent studies reached no satisfactory conclusion, as all studies differed in size, outcome and exposure, so that no reliable comparison is possible. Five studies described a slightly increased risk associated with HRT , whereas 15 did not. As in the case of endometrial carcinoma, the question is again whether these findings are due to induction or to a previously undiscovered ovarian carcinoma which becomes apparent under therapy. Currently no increased risk of ovarian cancer associated with HRT use can be assumed, because the evidence is inconclusive.
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Are There Alternatives For Women Who Choose Not To Take Menopausal Hormone Therapy
Women who are concerned about the changes that occur naturally with the decline in hormone production that occurs during menopause can make changes in their lifestyle and diet to reduce the risk of certain health effects. For example, eating foods that are rich in calcium and vitamin D or taking dietary supplements containing these nutrients may help to prevent osteoporosis. FDA-approved drugs such as alendronate , raloxifene , and risedronate have been shown in randomized trials to prevent bone loss.
Medications approved by the FDA for treating depression and seizures may help to relieve menopausal symptoms such as hot flashes . Drugs that have been shown in randomized clinical trials to be effective in treating hot flashes include venlafaxine , desvenlafaxine , paroxetine , fluoxetine , citalopram , gabapentin , and pregabalin.
Not An Elixir Of Youth
Hormone therapy is not a magic bullet or an elixir of youth, and it shouldnt be used willy-nilly, Manson says.
But women who are suffering with menopause symptoms should not be denied hormone therapy, she says, unless they are at increased risk of cardiovascular disease, breast cancer or other estrogen-sensitive cancers.
The pendulum has swung widely from the perception that hormone therapy is good for all women to the perception that its all bad for all women, to now a more appropriate place in between where hormone therapy is perceived to be good for some but not all women, Manson says. Were recommending that hormone therapy be used for the duration that its needed to address symptoms at the lowest effective dose and with ongoing reassessment of the balance of risks and benefits.
The time to start therapy is as soon as the symptoms start. Intervening earlier, rather than later, actually seems to carry less risk, Santoro says.
Once symptoms start, they are unlikely to get better soon. On average, the menopause transition lasts about four years, Santoro says. Some women have symptoms that persist even longer, however. Although there are exceptions, most women wont go through menopause before 45, Santoro says.
If youre 45 or older and starting to have hot flashes, night sweats or mood or sleep changes, it could be your hormones and it might be time to start some active management, she says.
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Breast Cancer Risk Linked To Hormone Therapy Can Persist For Years Study Says
Certain hormone replacement therapies have long been tied to an increased risk of breast cancer. Now, new research suggests that in some cases, that risk can persist for more than a decade.
The research, on Thursday, found that risks increased steadily the longer the hormone replacement therapy was used, and were greater for estrogen-progestogen hormone therapies than for estrogen-only hormone therapy. Every type of hormone replacement therapy, except for vaginal estrogens, was associated with excess breast cancer risks.
The menopausal transition most often begins between ages 45 and 55, causing symptoms to appear due to changes in the bodys production of the sex hormones estrogen and progesterone. Sometimes women take hormone replacement therapy, also called HRT or menopausal hormone therapy, to help relieve symptoms of menopause, such as hot flashes, night sweats, pain during sex and vaginal dryness. Those symptoms can be mild in some women but can impact the wellbeing of others. The hormones most commonly used to treat symptoms of menopause are estrogen and progesterone.
Strengths And Weaknesses Of This Study
Some limitations of this study arise from inevitable shortfalls in completeness and accuracy within any routinely collected dataset. A small proportion of women had missing information on smoking status, alcohol consumption, and BMI, but these were dealt with by multiple imputation. As we did not have reliable data for age at onset of menopause for all women, we estimated onset from the first menopause specific record before the earliest HRT prescription. For women with no such record we assumed onset within the most common age range of 50 to 54 years. We did not investigate the differences between continuous and sequential HRT because these regimens are prescribed at different times after menopause. As our cases and controls were matched by age, they would likely have been prescribed similar regimens, making a comparison infeasible. Our primary focus, anyway, was recent long term exposure.
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Hormone Replacement Therapy And Breast Cancer Risk
Hormone replacement therapy also called estrogen replacement therapy, menopausal hormone therapy, or post-menopausal hormone therapy can be an effective treatment for menopausal symptoms, but its important to know that some types of HRT can increase your risk of breast cancer.
HRT also can increase your risk of the cancer coming back if youve been diagnosed with breast cancer in the past. Because of this risk, doctors usually recommend that women with a history of breast cancer should not take types of HRT that affect the entire body .
HRT has also been linked to cardiovascular risks, such as heart disease, stroke, and blood clots.
However, all of these risks vary and depend on many factors, including:
-
how long you use it
Years ago, before the link between HRT use and breast cancer risk was known, many women took HRT for years to ease menopausal symptoms and prevent bone loss. After 2002, when research linked HRT and breast cancer risk, the number of women taking HRT dropped dramatically.
Newer research that has followed women for a longer amount of time suggests the link between HRT and breast cancer risk is more complex than first thought, and using HRT remains a controversial topic.
Does Estrogen Really Cause Breast Cancer
The short answer? No, it does not! Mis-information and outdated studies are what guides many to believe that estrogen can raise the risk of breast cancer in women. The questions we should be asking are: what does new research tell us and what do we know now?
Lets talk about a recent book about womens health: Estrogen Matters: Why Taking Hormones in Menopause Can Improve Womens Well-Being and Lengthen Their LivesWithout Raising the Risk of Breast Cancer. The author is Avrum Bluming, an oncologist with more than 20 years of experience treating cancer.
Dr. Bluming has gone through the many years of research including clinical research at his own practice and hes come up with some important conclusions. The number 1 thing he has said is that estrogen does NOT cause breast cancer. I think many women are fearful of this, and therefore avoid the use of hormone replacement therapy.
He has also found that estrogen prevents heart disease. Heart disease or cardiovascular disease is a leading cause of death in women. I think its important that we understand the role of estrogen and preventing it and prolonging our lives.
where I discuss the importance of hormones in regard to heart disease.
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Estrogen And Breast Cancer
The molecular form for one type of estrogenA female sex hormone that is primarily produced by the ovaries. Its primary function is to regulate the menstrual cycle and assist in the production of secondary sex characteristics such as breasts. It may even play a role in the production of cancer cells in the breast tissue. called estriol. High levels of estrogen in the body have been shown to be a risk factorAnything that increases or decreases a persons chance of developing a disease. for breast cancer.
High estrogen levels in the body are believed to dramatically increase our risk of breast cancer. It is therefore worth understanding what estrogen is and how you can control your estrogen level at the same time as other breast cancer risk factors.
Causes Of High Estrogen
High levels of estrogen can develop naturally, but too much estrogen can also result from taking certain medications. For example, estrogen replacement therapy, a popular treatment for symptoms of menopause, may cause estrogen to reach problematic levels.
Your body may also develop low testosterone or low progesterone levels, which can upset your hormonal balance. If you have estrogen levels that are abnormally high relative to your progesterone levels, its known as estrogen dominance.
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What Is Hormone Replacement Therapy
HRT medicines usually contain the hormones estrogen, progesterone, or both, to replace the hormones a womans body stops making after menopause.
HRT is different than hormonal therapy medicines that block estrogen to treat hormone receptor-positive breast cancer.
There are two main types of HRT:
-
combination HRT, which contains both estrogenand progesterone
Estrogen-only HRT usually is taken only by women who have had a hysterectomy .
Combination HRT usually is taken by women who still have their uterus. Estrogen-only HRT can cause the lining of the uterus to become too thick a condition called estrogen-associated endometrial hyperplasia. This can increase the risk of cancer of the uterus, called endometrial or uterine cancer. The progesterone in combination HRT helps to prevent thiscondition.
In combination HRT, both hormones can either be combined into one medicine or given as separate medicines. The same dose of estrogen and progesterone can be taken daily , or in different amounts on different schedules .
There are several ways to take or use HRT:
Systemic HRT effectively treats many symptoms of menopause, including hot flashes and night sweats. Topical HRT only works on vaginal symptoms, such as dryness and discomfort during sex.