No Menopause Harm Found in Estrogen
Estrogen pills ease older women through the change of life. The medicine smoothes out their hot flashes and mood swings. It keeps their hearts healthy and their bones strong.
Yet many are afraid of it.
The reason is the dark side of this useful and powerful hormone--the possibility that it will cause breast cancer.
“You can talk to women about their hearts and bones. But their primary fear is the risk of breast cancer,” said Dr. Janet Henrich of Yale University.
Dozens of studies over the years have looked at the possible link between estrogen replacement and this form of cancer. The results are dismayingly confusing.
Some seem to suggest that taking estrogen after menopause raises the risk of this terrifying disease, which strikes about 180,000 U.S. women annually. Others find no connection. Some even hint that estrogen somehow prevents breast cancer.
Now, experts have begun to try to make sense of these conflicting reports. Their findings should be reassuring for the millions of women who are at the change of life and beyond.
The emerging consensus suggests that a few years of estrogen use almost certainly does not cause breast cancer.
In a recent report in the Journal of the American Medical Assn., Henrich reviewed 24 studies and three so-called meta-analyses, reports that try to combine the results of smaller, inconclusive studies.
“In women who use estrogen for short periods of time, most of the evidence indicates that there is not an increased risk of breast cancer,” said Henrich.
She and several other experts say that women can take estrogen for five years and perhaps longer without putting themselves at higher risk of the disease.
About 75% of menopausal women experience symptoms of menopause, and for some they are severe. Typically they include hot flashes, vaginal dryness, poor sleep, trouble concentrating and tearfulness.
The symptoms result from the body’s sudden sharp drop in estrogen production. Replacing the hormone can make women feel dramatically better.
Dr. William Dupont of Vanderbilt University, who conducted one of the meta-analyses, said he tells menopausal women that if he was in their place, he would take estrogen and not worry about it.
“When my wife reaches menopause and if she is symptomatic, I will encourage her to go on estrogen and stay on as long as she wants,” Dupont said.
Women who have a family history of breast cancer are often discouraged from taking estrogen. However, Henrich said her review found “surprisingly little data” to show estrogen is bad for them, either.
Estrogen can also increase the risk of endometrial cancer, perhaps tenfold. However, this cancer is rare and highly curable if detected early.
Two other effects of estrogen have led some to recommend lifelong use of estrogen after menopause. Studies have shown that women who take the hormone may cut in half their risk of heart disease, the biggest killer of both women and men. Estrogen also appears to ward off osteoporosis, the brittle bone condition that leads to broken hips and other disabling fractures in old age.
Dr. Karen Steinberg of the U.S. Centers for Disease Control and Prevention in Atlanta conducted another of the recent meta-analyses. She said her results suggest that the risk of breast cancer is about 30% higher than usual after 15 years of estrogen use.
However, she said that much of the increase found in her analysis results from including statistics from European studies. In Europe, the risk may be higher because doctors often prescribe different types and doses of estrogen.
Even if estrogen does sometimes cause breast cancer, experts say the treatment may well save more lives than it takes by reducing the hazards of heart disease and osteoporosis.
