Very large research studies have shown that using hormone replacement therapy (HRT) increases breast cancer risk. After the results were published, many post-menopausal women all over the world stopped using HRT.
The study reviewed here found that overall use of HRT dropped dramatically among Australian women over 50 -- from about 20% in 2004 to about 12% in 2008. Still, women who are using HRT are increasingly using unapproved alternative forms of HRT. In 2004 use of unapproved alternative forms of HRT was rare, but by 2008 25% of the Australian women in this study who were taking HRT were using an unapproved, unregistered form of HRT.
This study, the South Australian Health Omnibus Study, asked post-menopausal Australian women about their use of HRT each year for 17 years. Other studies have shown that the link between HRT use and breast cancer risk has likely caused similar declines in HRT use among women in the United States. It's also likely that among women taking HRT, use of unapproved forms of HRT is on the rise worldwide.
Increasing numbers of post-menopausal women may be using unapproved forms of HRT, believing they may help relieve hot flashes without raising breast cancer risk. There is NO EVIDENCE that this is true. Manufacturers of unapproved forms of HRT may claim that the products are safe and effective. Again, there is NO EVIDENCE for these claims. The ingredients in these unapproved, alternative forms of HRT:
Some of these alternative HRT products contain the hormone estriol, a form of estrogen naturally produced during pregnancy. While estriol is a "natural" substance, it has never been carefully studied and it has never been shown to relieve menopausal symptoms. Also, it's never been shown that it's safe to take estriol as HRT. Since estriol is a form of estrogen, it might increase breast cancer risk and may have other, unknown health risks.
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. Using an unapproved alternative form of HRT shouldn't be an option. Ask your doctor how you can minimize your breast cancer risk AND relieve your symptoms. Be sure to discuss the pros and cons of different types of approved HRT. Other research suggests that estrogen-only HRT appears to increase breast cancer risk less than combination HRT. If you do decide to take HRT, ask if you can take a lower-dose formula and try to take it for the shortest time possible.
Learn more about more about menopause and ways to manage side effects in the Breastcancer.org Managing Menopausal Symptoms section.
SAN FRANCISCO, April 20 (MedPage Today) -- As the popularity of hormone replacement therapy continues to drop, women who do use it around the time of menopause increasingly choose alternative forms, Australian researchers found.
About 22% of Australian women over age 50 used hormone therapy in 2000 -- before news broke about HRTs' cardiovascular and breast cancer risks. By 2008, only 11.8% of women over 50 used it, Alastair MacLennan, M.D., of the University of Adelaide, Australia, and colleagues said.
And, while use of unapproved alternative medicines for hormone therapy was rare in 2004, alternative drugs accounted for 25 percent of HRT in 2008, the researchers reported in the April edition of Climacteric.
"It's extremely important that women receive the correct treatment, rather than try something which may have no effect or may even be harmful," David Sturdee, M.D., of Solihull Hospital in England and president of the International Menopause Society, said in a statement.
No herbal product or supplement has been shown to have more than a placebo effect in a quality, randomized, controlled trial of hormone therapy, Dr. MacLennan's group noted.
So-called bioidentical hormones and herbal remedies are untested for long-term safety and efficacy.
In a statement, Dr. MacLennan said these products capitalize on women's fears, which are understandable since "most objective observers would agree that the risks of hormone replacement therapy were overstated following the early results of part of the U.S. Women's Health Initiative study in 2002."
Hormone therapy prescriptions plunged worldwide after that study revealed a 24% or higher excess risk of breast cancer among women taking estrogen plus progesterone.
"These scares have led to hormone replacement therapy use dropping, but for many women, the need for help through the menopause has not gone away," Dr. MacLennan said.
Both he and Dr. Sturdee urged women to talk to a qualified doctor before choosing any treatment for menopause symptoms.
The researchers followed women's menopausal hormone use over 17 years in the annual population-based surveys of the South Australian Health Omnibus Study.
Use of hormone therapies reported by women over age 50 rose in the surveys from about 14% in 1991 to their peak in 2000. Thereafter, use declined over time (P=0.004).
The matching trajectory of HRT among women aged 40 and older also showed a significant decline (P<0.001).
By 2008, use of hormone therapy drugs approved by Australian regulatory authorities was 9.6% among the 953 women over 40 and 11.8% among the 688 women ages 50 or older.
By comparison, the rate of current use in 2004 was 19.8%.
By 2008 3.1% of women over 40 reported using either HRT products from compounding pharmacies, or complementary/alternative medicines which they thought contained hormones. Usage was 4.0% among women 50 and holder.
Use of these "unregistered" hormonal products was highest among 50- to 59-year olds at 7.7%, compared with 13.4% using approved hormone therapy use.
Notably, researchers said the decline in hormone replacement therapy use appeared to be due in part to shorter duration -- the mean length of approved hormone therapy in the 2000 survey was 15.3 years, compared with 10.5 years in 2008.
"This reduction in the length of hormone therapy use may reflect appropriate review and cessation of long-term therapy, where women were encouraged to try [going] off therapy every few years and had no recurrence of symptoms," the researchers said.
However, the continuing drop in use overall may also reflect confusion among some physicians over mixed messages about the risks and benefit of hormone therapy.
Doctors may also be reluctant "to spend the long consulting times often needed to tailor advice and therapy when a newly symptomatic woman first seeks their help," they said.
"There need to be better rewards for accurate counseling about well-tested therapies and no hidden rewards for advocating unproven and potentially dangerous therapies," Dr. MacLennan's group concluded.
The study was funded by the University of Adelaide. The researchers reported no conflicts of interest.
Primary source: Climacteric Source reference: MacLennan AH, et al "Continuing decline in hormone therapy use: population trends over 17 years" Climacteric 2009; 12: 122-30.
Breastcancer.org 7 East Lancaster Avenue, 3rd Floor Ardmore, PA 19003
Learn more about our commitment to your privacy
© 2009 Breastcancer.org - All rights reserved.
Breastcancer.org is a non-profit organization dedicated to providing information and community to those touched by this disease. Learn more about our commitment to providing complete, accurate, and private breast cancer information.
