HRT (hormone replacement therapy) and breast cancer

This section is for women who may have questions about HRT, hormone replacement therapy, and its relationship to breast cancer. We hope it answers some of your questions and helps you to discuss your treatment with your GP or your specialist breast care team.

Page Contents

What is HRT?
What types of HRT are available?
Benefits and risks of HRT
Are there alternatives to HRT?
Help from Action Breast Cancer

What is HRT?

HRT, hormone replacement therapy, is used to control the symptoms of menopause. The menopause occurs when a woman’s menstrual cycle (periods) stops and she can no longer have children. It is often called the change of life. The average age for menopause in women is 52 years. Menopausal symptoms occur because the female hormones progesterone and oestrogen are produced in smaller amounts by the body. HRT refers to the artificial replacement of these hormones. Following discussion with your doctor HRT is usually started to control of menopausal symptoms including hot flushes, night sweats, vaginal dryness, poor concentration and other conditions. These can be quite severe in some women and very mild in other women. HRT is sometimes used to prevent osteoporosis. This is a condition caused by low levels of oestrogen. It causes bones to become brittle and may result in fractures (broken bones). However, HRT should not be the first drug of choice as there are alternatives available.
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What types of HRT are available?

There are two types of HRT. One type consists of oestrogen alone and the other is a combination of both oestrogen and progesterone. Women who have a uterus (womb) need to have progesterone as well as oestrogen in their HRT preparation. This is to protect the lining of the uterus. Women who have had a hysterectomy (removal of the womb) can use oestrogen alone. In younger women, generally under 54 years, HRT is given in such a way as to produce a monthly bleed. In women over 54 years HRT is given in such a way as to avoid a monthly bleed. HRT can be taken in tablet form or as a patch or gel. Sometimes an implant may be used. Your doctor will discuss which route is best for you.
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Benefits and risks of HRT

Benefits

• HRT reduces the symptoms caused by the menopause.
• HRT decreases the risk of bone fractures caused by osteoporosis.
• Recent studies have shown that HRT decreases the risk of colon cancer.
  

Risks

• Blood clots – there is a small increase in the risk of blood clots occurring in the legs and the lungs in women taking HRT. This risk is greatest in the first year of HRT.
• Breast Cancer - there is as an increased risk of breast cancer associated with the use of HRT. The increase becomes apparent within 1-2 years of starting HRT. Recent studies have shown that the risk is related to the length of time a woman is on HRT. This is seen more with combined HRT, that is oestrogen and progesterone, rather than with oestrogen alone. However, in all cases, the risk of breast cancer begins to decrease when HRT is stopped and after five years reaches the same level as in women who have never taken HRT. Before a woman starts taking HRT her doctor should review her own and her family’s medical history. Women who are on HRT should be breast aware, (for a free copy of Breast Awareness leaflet call the National Cancer Helpline on freefone 1800 200 700) have an annual breast examination carried out by their doctor, and a mammogram (breast X-ray) every two years. As HRT can increase breast density, it is important that the doctor who is reading your mammogram knows you are on HRT. HRT is not recommended for women who have a history of breast cancer or who have an un-investigated breast lump. However, if menopausal symptoms are very severe and affecting a woman’s quality of life, her GP may consider a shortterm, low dose trial of HRT with close monitoring.
• Endometrial cancer (cancer of the womb) – oestrogen only HRT increases the risk of endometrial cancer. This type of HRT should never be used in a woman who still has a uterus.
• The role HRT plays in heart disease remains unclear.
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Are there alternatives to HRT?

The menopausal years are a natural part of a woman’s life. Some may require assistance with the changes that occur during these years. Although HRT can have beneficial effects, there are health concerns associated with its use and many women may not feel that hormones are a good choice for them. Women should discuss with their GP whether to take hormones and what alternatives are available.

All women can adopt a healthy lifestyle, such as not smoking, regular exercise and good nutrition. Many women find relief from short-term menopause related changes with non-prescription remedies such as oestrogen containing foods (soy products, wholegrain cereal and certain fruits and vegetables). Local nonhormonal therapy is available for vaginal dryness. Short-term symptoms may stop without any therapy. Non-hormonal medication, such as raloxifene and aledronate, may be prescribed for osteoporosis. For further information on the menopause and alternative therapies call National Cancer’s Helpline on Freefone 1800 200 700 and ask for our factsheet Understanding and Managing Menopausal Symptoms.
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Help from Action Breast Cancer

Action Breast Cancer is a national project established by the Irish Cancer Society to provide breast cancer information and support and to fund breast cancer research. Its services are free, confidential and accessible. For more information call the Action Breast Cancer Helpline on Freefone 1800 200 700 or visit www.cancer.ie
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ABC would like to thank Breast Cancer Care in the UK for their permission to adapt the text in this factsheet from their series of factsheets.