HT Therapy for Relief

By , August 13, 2010 8:29 pm

This study, which reports increased tumor size and lymph node spread in patients using E+P, adds to the evidence against the use of long-term HT therapy in asymptomatic older women. For symptomatic women who are younger (ages 45 to 55 years) and at less risk for breast cancer as a function of age, HT can still be considered for relief of moderate-to-severe menopausal symptoms after full discussion of the risks and benefits and consideration of other alternatives. This study should increase our caution in using HT, and stresses the need for individual discussions and use of the lowest effective dose of both estrogen and progestin for the shortest duration.

Research is needed regarding the safety and efficacy of lower doses of estrogen alone, more creative progestin dosing for uterine protection such as menopausal progesterone intrauterine devices (IUDs), and additional options for vasomotor relief such as the selective serotonin reuptake inhibitors (SSRIs) and serotonin/norepinephrine reuptake inhibitors (SNRIs).

The question then remains as to whether all patients who have had breast cancer should be denied the benefits of estrogen replacement therapy. This is particularly relevant in the patient who has serious quality of life issues before her. At present, therapy with ERT/HRT is indicated in the management of quality of life issues, using lowest possible dose of hormone for shortest duration of time possible. Is it appropriate to deny a woman the option of taking replacement therapy for relief of her symptoms when there is no clinical evidence that it adversely affects outcome?

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