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Doctors Continue to Prescribe Standard-Dose Hormone Replacement Therapy

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Very large studies have shown that using hormone replacement therapy (HRT) increases the risk of hormone-receptor-positive breast cancer, especially at the higher doses that were used routinely used in the past. Still, a study found that despite this clear link between standard-dose HRT and breast cancer, many doctors continue to regularly prescribe standard-dose HRT -- either estrogen-only HRT or combination HRT (which contains estrogen and progesterone) -- instead of low-dose HRT.

The results come from an ongoing survey of U.S. doctors asking how they manage their patients, including the prescriptions they write. The survey, called the National Disease and Therapeutic Index (NDTI), has been tracking 1,800 physicians since 2001.

Using NDTI information, the researchers calculated that 6.1 million HRT prescriptions were written in 2009, compared to 16.3 million in 2001 (a drop of about 66%). Overall, the number of HRT prescriptions has been steadily declining since 2002 when results from the Women's Health Initiative study (WHI) showed that standard-dose combination HRT increased breast cancer risk.

  • Most of the HRT prescriptions written in 2009 were for standard-dose HRT (either combination or estrogen-only) taken by mouth (oral).
  • The number of prescriptions for low-dose oral HRT formulations went up from 700,000 in 2001 to 1.3 million in 2009. Still, this is only 29% of all HRT prescriptions written in 2009, even though low-dose oral HRT (especially low-dose estrogen-only oral HRT) is associated with a lower risk of breast cancer compared to standard-dose oral HRT.
  • Vaginal or transdermal (skin patch) HRT formulations weren't prescribed very often in 2009, even though these alternatives to oral HRT also are associated with a lower risk of breast cancer compared to standard-dose oral HRT.

The researchers believe that when HRT is needed, doctors should generally prescribe low-dose oral HRT formulations (or vaginal or transdermal HRT) over standard-dose oral HRT to treat menopausal symptoms.

Menopausal side effects can dramatically reduce quality of life for some women. These women 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 HRT, talk to your doctor about all of your options. Ask how you can minimize your breast cancer risk AND relieve your symptoms. Be sure to discuss the pros and cons of different types of HRT. If you do decide to take HRT, ask if you can take an estrogen-only, low-dose formulation and try to take it for the shortest time possible. You also may want to ask about vaginal or transdermal HRT.

Learn more about more about menopause and ways to manage side effects in the Breastcancer.org Managing Menopausal Symptoms pages.

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