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Society Releases New Guidelines on Hormone Replacement Therapy

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Some women take hormone replacement therapy (HRT) to help ease some of the bothersome side effects of menopause. The North American Menopause Society has released new guidelines for using HRT. The guidelines recommend a bone mineral density test after stopping long-term HRT. If bone density is low, women should consider taking a bone-strengthening medicine.

The Women's Health Initiative (WHI) study suggested that taking combination HRT (HRT with both estrogen and progesterone) may contribute to higher breast cancer risk. Women already diagnosed with breast cancer who take HRT may increase their risk of recurrence (the cancer coming back); HRT also may cause a worse prognosis. HRT use also increases ovarian cancer risk.

But the effect of menopausal symptoms on some women's quality of life can be dramatic; HRT may offer some relief. Besides easing severe menopausal symptoms, HRT also can help maintain or improve bone health. When a women stops taking HRT, bones may weaken over time and the risk of osteoporosis and broken bones goes up. This is why the new guidelines recommend bone health be monitored after HRT is stopped.

Bisphosphonates are medicines that help prevent bone loss and can build bone strength. The bisphosphonates are:

  • Fosamax (chemical name: alendronate)
  • Actonel (chemical name: risedronate)
  • Aredia (chemical name: pamidronate)
  • Bonefos (chemical name: clodronate)
  • Boniva (chemical name: ibandronate)
  • Reclast and Zometa (chemical name: zoledronic acid)

Some bisphosphonates, such as Fosamax and Actonel, are pills taken by mouth. Zometa, Aredia, and Bonefos are given intravenously. Bisphosphonates taken by mouth need to be taken in a specific way and all bisphosphonates may cause serious side effects.

Women with severe menopausal side effects have to weigh the benefits of HRT against the risks. If you're having severe hot flashes or other menopausal side effects and are considering taking HRT, talk to your doctor about how you can minimize your breast cancer risk. Be sure to discuss the pros and cons of different types of HRT and how you can take HRT for the shortest time possible.

Keep these two points in mind when you talk to your doctor:

  • Estrogen-only HRT appears to increase breast cancer risk less than combination HRT.
  • Research shows using combination HRT for fewer than 3 years doesn't significantly raise breast cancer risk.

Together, you and your doctor can decide if HRT or another treatment might be right for you and your unique situation. If you do decide to use HRT, try to make healthy lifestyle choices that can lower your breast cancer risk. During and after HRT, make sure to follow the recommendations for breast cancer screening, including monthly breast self-exams, annual mammograms, and physical examinations by your doctor. When you stop HRT, work with your doctor to make a plan to monitor and manage your bone health over time.

You can learn more about measuring bone health and ways to keep your bones healthy and strong in the Breastcancer.org Bone Health section.

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