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HORMONE THERAPY

Understanding Signs of Menopause, Estrogen Deficiency and Cancer Risk

For many women experiencing signs of menopause, hormone replacement therapy (HRT) is a welcome option for fighting back symptoms such as hot flashes and helping to prevent bone loss. But for women who have cancer risk or who have a family history of cancer the choice is more complicated for treating estrogen deficiency. Menopause is caused by an estrogen deficiency, and HRT therapies seek to replace the estrogen that has been lost. Estrogen can be used alone or with progestin to treat menopausal symptoms. Despite its benefits, estrogen can also put women at higher cancer risk for breast, endometrial or uterine cancers. It's a risk that can make using HRT a problematic choice.

What is Menopause?

During menopause, the ovaries stop releasing eggs and reduce the production of estrogen and progesterone. This drop in hormone production can cause signs of menopause such as hot flashes, moodiness, weight gain and even more severe and permanent issues such as thinning, brittle bones, vaginal dryness and pain. Surgical removal of the ovaries, including total hysterectomy, will bring on early menopause. Women who have had their uterus removed but still have their ovaries don't go through menopause until their ovaries stop working.

What Causes Menopausal Symptoms?

Most of the signs of menopause are linked to lower estrogen levels. While some symptoms such as hot flashes and night sweats, decrease over time, issues such as bone loss and vaginal dryness can worsen with time. 

What Hormones are Used to Treat the Signs of Menopause?

The hormones most commonly used to treat signs of menopause are estrogen and progesterone. Often, these two hormones are used together, but some women are given estrogen alone. It's important to discuss all of your options and learn about the possible risks.

  • Estrogen-progestin therapy - Treating menopausal symptoms with estrogen and progestin together is a standard course of action. While estrogen alone increases the risk of uterine cancer, adding a progestin to the estrogen lowers that risk to a normal level. Women who still have a uterus are typically advised to use an estrogen-progestin HRT to keep their risk levels lower.  
  • Estrogen therapy - Treating menopausal symptoms with estrogen alone improves the signs of menopause, but it increases breast cancer risk and the risk of endometrial or uterine cancer. However, it is a safe option for women who have had their uterus removed through hysterectomy.  

HRT After Breast Cancer

Women who have had breast cancer, however, are advised to stay away from HRT and instead seek out non-hormonal options to manage menopausal symptoms. Estrogen, even that produced by a woman’s own body, can increase cancer risk and the chance for recurrence.

How are Hormones Delivered to the Body?

Systemic hormones - Hormones can be given systemically, such as with a pill, so that they enter the bloodstream and circulate to reach all parts of the body. Systemic hormone therapy includes estrogen and progestin combination pills as well as pills that contain each drug separately

Systemic hormones are used to alleviate signs of menopause, such as hot flashes and night sweats, as well as thinning vaginal walls and vaginal dryness. Because the hormones are distributed throughout the body, systemic delivery is also a way to help prevent and treat osteoporosis.

Topical hormones - Hormones, most often estrogen, can also be infused into a hormonal replacement cream that can be placed in or near the place that needs treatment. This topical hormone therapy allows very little hormone to be absorbed into the bloodstream, minimizing the impact on the body as a whole. For example, vaginal pain or dryness can be treated with minimal doses of estrogen and can be placed inside the vagina, where most of the hormone remains in the vaginal tissues. Because the effects of topical treatment are localized, they don't treat symptoms such as hot flashes or osteoporosis.

What are the Risks of HRT?

While HRT can help many women get through menopause, HRT, and especially estrogen-only treatment can increase a woman's breast and uterine cancer risk and chances of developing:

  • Pulmonary embolism
  • High blood pressure
  • Deep vein thrombosis
  • Gallbladder disease
  • Heart attack
  • Stroke

If you have questions about the benefits and risks of HRT, contact our expert team at Coyle Institute. As the area's only urogynecology practice, we can address the full scope of concerns that accompany menopause and perimenopause. We are experienced in working with cancer survivors to help them reclaim their confidence and sexuality after treatment. Call us today and schedule your consultation.