Adverse Effects of HRT in menopause
Adverse Effects of HRT.
* Heart Disease. In spite of estrogen's benefits on cholesterol levels and other factors that affect the heart, evidence suggests that HRT does not prevent heart disease. In fact, it may actually be harmful for women with existing heart disease, at least in the first few years, and may also worsen the outlook after a heart attack. However, a 2004 review of 30 studies found that HRT does not significantly impact mortality from cardiovascular disease.
* Stroke. Studies have reported a slightly increased risk of stroke in women taking HRT within the first two years of treatment and in HRT users with a history of major stroke or small strokes (transient ischemic attacks). A 2005 review found that HRT increased the risk of stroke, particularly ischemic (a type of stroke caused by an interruption in blood flow to part of the brain) stroke. In addition, HRT appears to worsen the outlook for women who have had a stroke.
* Mental Decline. Observational studies had suggested that hormone replacement therapy (HRT) helped prevent mental decline and even Alzheimer's disease after menopause. Other studies have found no differences in mental performance and no protection from Alzheimer's disease in women taking HRT compared to non-users. A 2004 review of the Women’s Health Initiative Memory Study found that combined HRT did not reduce the risk of cognitive impairment, and actually increased the risk of dementia among women ages 65 and over.
* Thromboembolism. HRT is associated with a higher risk for thromboembolism, in which blood clots form in deep veins. This places women at risk for pulmonary embolism, in which the blood clot travels to the lungs.
* Breast Cancer. Because breast tissue growth is highly sensitive to estrogens, the more a woman is exposed to estrogen over her lifetime, the higher the risk for breast cancer. A number of studies have now reported a higher risk for breast cancer in postmenopausal women taking HRT that contains both estrogen and progestin. A 2005 study suggested that HRT with no or low progestin is safer than standard combination therapy. Several 2006 studies of women who had a hysterectomy indicated that estrogen alone does not increase overall breast cancer risk when the drug is used for 7 years or less. However, women who take the drug for 15 years or more do have an increased risk. Women who are at low risk for breast cancer tend to have fewer breast cancers with estrogen alone, while women at higher risk tend to have more breast cancers. In addition, estrogen therapy may cause abnormal mammogram results. Breast tissue density increases with HRT, which makes mammograms more difficult to read and leads to more breast biopsies. Women who take estrogen HRT should be aware that they need frequent mammogram screenings.
* Endometrial (Uterine) Cancers. Estrogen overstimulates the tissue lining the uterus (the endometrium) and causes uncontrolled cell growth, a condition known as hyperplasia, which is a strong risk factor for cancer. Taking unopposed estrogen replacement therapy (ERT) increases the risk of endometrial cancer at least five-fold. Adding progestin to HRT appears to pose no risk for this cancer.
* Ovarian Cancer. Whether HRT increases the risk for ovarian cancer is unclear, although evidence does seem to suggest a higher risk with the use of unopposed estrogen. Short term used of combined HRT in one study did not increase the incidence of ovarian cancer. Another study reported that women who had used unopposed estrogen or HRT with sequential use (but not continuous use) of progestins were at higher risk. Studies to date, however, have been limited. (Ovarian cancer is very uncommon, with the mortality rate being 43 out of every 100,000 women. Even among long-term HRT users this rate increases only to 64.)
* Gallstones. HRT is associated with a higher risk for gallstones.
Other Drugs Used for Menopausal Symptoms
Despite its risks, hormone replacement therapy appears to be the best treatment for hot flashes.
* Heart Disease. In spite of estrogen's benefits on cholesterol levels and other factors that affect the heart, evidence suggests that HRT does not prevent heart disease. In fact, it may actually be harmful for women with existing heart disease, at least in the first few years, and may also worsen the outlook after a heart attack. However, a 2004 review of 30 studies found that HRT does not significantly impact mortality from cardiovascular disease.
* Stroke. Studies have reported a slightly increased risk of stroke in women taking HRT within the first two years of treatment and in HRT users with a history of major stroke or small strokes (transient ischemic attacks). A 2005 review found that HRT increased the risk of stroke, particularly ischemic (a type of stroke caused by an interruption in blood flow to part of the brain) stroke. In addition, HRT appears to worsen the outlook for women who have had a stroke.
* Mental Decline. Observational studies had suggested that hormone replacement therapy (HRT) helped prevent mental decline and even Alzheimer's disease after menopause. Other studies have found no differences in mental performance and no protection from Alzheimer's disease in women taking HRT compared to non-users. A 2004 review of the Women’s Health Initiative Memory Study found that combined HRT did not reduce the risk of cognitive impairment, and actually increased the risk of dementia among women ages 65 and over.
* Thromboembolism. HRT is associated with a higher risk for thromboembolism, in which blood clots form in deep veins. This places women at risk for pulmonary embolism, in which the blood clot travels to the lungs.
* Breast Cancer. Because breast tissue growth is highly sensitive to estrogens, the more a woman is exposed to estrogen over her lifetime, the higher the risk for breast cancer. A number of studies have now reported a higher risk for breast cancer in postmenopausal women taking HRT that contains both estrogen and progestin. A 2005 study suggested that HRT with no or low progestin is safer than standard combination therapy. Several 2006 studies of women who had a hysterectomy indicated that estrogen alone does not increase overall breast cancer risk when the drug is used for 7 years or less. However, women who take the drug for 15 years or more do have an increased risk. Women who are at low risk for breast cancer tend to have fewer breast cancers with estrogen alone, while women at higher risk tend to have more breast cancers. In addition, estrogen therapy may cause abnormal mammogram results. Breast tissue density increases with HRT, which makes mammograms more difficult to read and leads to more breast biopsies. Women who take estrogen HRT should be aware that they need frequent mammogram screenings.
* Endometrial (Uterine) Cancers. Estrogen overstimulates the tissue lining the uterus (the endometrium) and causes uncontrolled cell growth, a condition known as hyperplasia, which is a strong risk factor for cancer. Taking unopposed estrogen replacement therapy (ERT) increases the risk of endometrial cancer at least five-fold. Adding progestin to HRT appears to pose no risk for this cancer.
* Ovarian Cancer. Whether HRT increases the risk for ovarian cancer is unclear, although evidence does seem to suggest a higher risk with the use of unopposed estrogen. Short term used of combined HRT in one study did not increase the incidence of ovarian cancer. Another study reported that women who had used unopposed estrogen or HRT with sequential use (but not continuous use) of progestins were at higher risk. Studies to date, however, have been limited. (Ovarian cancer is very uncommon, with the mortality rate being 43 out of every 100,000 women. Even among long-term HRT users this rate increases only to 64.)
* Gallstones. HRT is associated with a higher risk for gallstones.
Other Drugs Used for Menopausal Symptoms
Despite its risks, hormone replacement therapy appears to be the best treatment for hot flashes.
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