Although this is not the same as menopause, it can lead to many of the same symptoms. Most of the symptoms of menopause are linked to lower estrogen levels. Some symptoms — hot flashes and night sweats, for instance — tend to fade away at some point, whether or not they are treated.
Other problems that start after menopause, like dryness and thinning of vaginal tissues and bone thinning, tend to get worse over time. Because many of the symptoms and problems of menopause are linked to low levels of estrogen, this hormone has often been used in the past to treat menopause. The hormones most commonly used to treat symptoms of menopause are estrogen and progesterone. Progesterone and drugs that act like it are called progestins. Often, these 2 hormones are used together, but some women are given estrogen alone. Some preparations contain both an estrogen and a progestin.
Androgens male hormones like testosterone are also sometimes used to treat menopausal symptoms. Tibolone is a synthetic hormone drug that can act like estrogen, progesterone, and testosterone in different tissues of the body. Treating menopausal symptoms with estrogen and progestin together is known as estrogen-progestin therapy EPT or combined hormone therapy.
Although estrogen alone improves the symptoms of menopause, it increases the risk of cancer of the uterus endometrial cancer. Adding a progestin to the estrogen lowers the risk of endometrial cancer back to normal. Because of this, EPT is given to women who still have a uterus those who have not had a hysterectomy. EPT can be given 2 ways:.
Sometimes, how much of the hormones the woman takes are adjusted based on blood tests of hormone levels. But so far, there are no long-term studies of bio-identical hormones, and no studies have found that women taking bio-identical hormones have less serious side effects than women taking other forms of these hormones. For this reason, bio-identical hormones should be assumed to have the same health risks as any other type of hormone therapy. Some herbal remedies and supplements are also described as natural ways to treat the symptoms of menopause.
Treating menopausal symptoms with estrogen alone is known as estrogen therapy ET.
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ET improves the symptoms of menopause, but it increases the risk of cancer of the uterus endometrial cancer. Hormones can be given so that they enter the bloodstream and circulate to reach all parts of the body. Systemic hormone therapy includes:. Systemic hormones can help with certain symptoms of menopause, such as hot flashes and night sweats, as well as problems linked to thinning of the lining of the vagina such as dryness that can make sex painful.
They can also help prevent and treat osteoporosis severe bone thinning. Hormones, most often estrogen, can also be placed in or near the place that needs treatment. This is called topical hormone therapy. If small doses are used, little of the hormone is absorbed into the bloodstream, so it has little if any effect on the rest of the body. For women in menopause, very small doses of estrogen can be placed inside the vagina as topical therapy to help treat dry or thinned vaginal tissues.
This type of estrogen comes in the form of vaginal creams, rings, and tablets. Even though tiny amounts of hormone may enter the blood, most of it stays in the vaginal tissues. Generally, topical estrogen is not needed in women taking systemic hormones. Different types of studies can be used to look at cancer risk from menopausal hormone therapy MHT. Randomized controlled trials: In this kind of study, a group of patients get the drug being studied like MHT , and another control group gets a placebo like a sugar pill. Results from this kind of study are powerful because which group a patient is in is based on chance.
This is the best way to see the effects of a drug. These types of studies can also be double-blinded, which means neither the people in the study nor their doctors know which group they are in. This lowers the chance that thoughts or opinions about treatment could affect the study results.
Menopausal Hormone Therapy and Cancer
Unfortunately, these kinds of studies are costly, which limits the number of people in the study, how long the study can continue, and the number of studies done. In observational studies of MHT, the women and their doctors decide what hormone drugs, if any, the women take and for how long.
These kinds of studies can also gather information about other factors that can influence cancer risk. Some observational studies gather data about what happened over previous years.
Estrogen & Hormones
Others follow observe people for years to look at how different factors like MHT affect cancer risk. This makes it less clear that the differences seen are only due to the drug being studied like MHT and not other factors. When observational studies and randomized controlled trials have different results, most experts give more weight to the results of the randomized controlled trial. Several large studies have looked at possible links between systemic hormone therapy in menopausal women and different types of cancer. The WHI also conducted some observational studies.
Many observational studies have looked at MHT and cancer risk. One example is the Million Women Study. It enrolled over a million women aged 50 to 64 in the UK, collected information about hormone use and other health and personal details, and followed the women for many years. Some of the women on ET still had their uterus. Studies show that EPT does not increase the risk of endometrial cancer cancer in the lining of the uterus.
It is linked to a higher risk of abnormal vaginal bleeding. Because vaginal bleeding after menopause can be a symptom of endometrial cancer, this often leads to further testing. The longer EPT is used, the higher the risk. The risk returns to that of a woman who never used EPT the usual risk within 3 years of stopping the hormones. Breast cancers in women taking EPT are more likely to be found when they are bigger and have spread beyond the breast.
To put the risk into numbers, if 10, women took EPT for a year, it would result in up to about 8 more cases of breast cancer per year than if they had not taken hormone therapy HT. Taking EPT is also linked to increased breast density as seen on a mammogram. Increased breast density can make it harder to find breast cancer on a mammogram. Risk factors for ovarian cancer are harder to study because it is a less common cancer.
Even when something increases the risk of developing ovarian cancer, the risk of actually getting this cancer is still likely to be low.
Although there were more cases of ovarian cancer in the women on EPT, this may have been due to chance because of the small number of women who were affected with this cancer. However, a recent analysis combined the results of more than 50 studies, including randomized controlled trials and observational studies. This analysis found that women who took estrogen and progestin progesterone after menopause did have an increased risk of getting ovarian cancer. The risk was highest for women taking hormones, and decreased over time after the hormones were stopped.
To put the risk into numbers, if 1, women who were 50 years old took hormones for menopause for 5 years, one extra ovarian cancer would be expected to develop. Women who took EPT had a lower risk of getting colorectal cancer at all, but the cancers they got were more advanced more likely to have spread to lymph nodes or distant sites than the cancers in the women not taking hormones.
Some observational studies have found a lower risk of colorectal cancer in women taking EPT, but some did not. So far, though, observational studies have not linked EPT with a higher risk of colorectal cancer. EPT is not linked to a higher risk of getting lung cancer , but it is linked to a higher risk of dying from lung cancer.
EPT is not linked to a higher risk of any type of skin cancer including both melanoma and other types of skin cancer. In women who still have a uterus, using systemic ET has been shown to increase the risk of endometrial cancer cancer of the lining of the uterus. The risk remains higher than average even after ET is no longer used. Although most studies that showed an increased risk were of women taking estrogen as a pill, women using a patch or high-dose vaginal ring can also expect to have an increased risk of endometrial cancer.
Because of this increased cancer risk, women who have gone through menopause and who still have a uterus are given a progestin along with estrogen. Studies have shown that EPT does not increase the risk for endometrial cancer. Long-term use of vaginal creams, rings, or tablets containing topical estrogen doses may also increase the levels of estrogen in the body. ET is not linked to a higher risk of breast cancer. In fact, certain groups of women taking ET, such as women who had no family history of breast cancer and those who had no history of benign breast disease, had a slightly lower risk of breast cancer.
This analysis found that women who took estrogen after menopause did have an increased risk of getting ovarian cancer. The risk was highest for women currently taking estrogen, and decreased over time after estrogen was stopped. To put the risk into numbers, if 1, women who were 50 years old took estrogen for menopause for 5 years, one extra ovarian cancer would be expected to develop. Observational studies have shown that women who take ET have a higher risk for ovarian cancer compared with women who take no hormones after menopause.
The overall risk remains low, but it does increase the longer a woman uses ET. The risk of ovarian cancer goes down after a woman stops taking the hormone.
The use of hormonal treatment in relapsed epithelial ovarian cancer | Cochrane
Observational studies have found a lower risk of colorectal cancer in women who have used ET for many years. ET does not seem to have any effect on the risk of lung cancer. ET is not linked to a higher risk of any type of skin cancer including both melanoma and other types of skin cancer. The decision to use estrogen, alone ET or with a progestin therapy EPT , after menopause should be made by each woman and her doctor after weighing the possible risks and benefits.
Things to think about include:. And just as you would if you were taking another type of medicine, you need to see your doctor regularly. Your doctor can see how well the treatment is working, monitor you for side effects, and let you know what other treatments are available for your symptoms. All women should report any vaginal bleeding that happens after menopause to their doctors right away — it may be a symptom of endometrial cancer. A woman who takes EPT does not have a higher risk of endometrial cancer, but she can still get it.
Women using vaginal cream, rings, or tablets containing only estrogen should talk to their doctors about follow-up and the possible need for progestin treatment. Adding a progestin does raise the risk of breast cancer, so ET is a better option for women without a uterus.
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Women should follow the American Cancer Society guidelines for cancer early detection, especially those for breast cancer. These include vitamins and soy-based and herbal products like black cohosh and red clover. There are also endless arrays of special blends of herbs and vitamins that claim to reduce the discomforts of menopause.
These products are considered dietary supplements not drugs. They have not been evaluated by the Food and Drug Administration FDA to be sure that they work or even that they are safe. You should discuss herbs or supplements with your doctor before taking them.
Well-controlled scientific studies are needed to help find out if these products work and if they are any safer than the hormone therapy drugs now in use. The American Cancer Society medical and editorial content team. Provides accurate, up-to-date cancer information to patients, their families, and the general public. No matter who you are, we can help. Evidence: Understandably some women look for a safer alternative for symptom relief. Premarin is synthesized from the urine of pregnant mares and contains a mix of estrogens some unique to horses , steroids, and various other substances.
Might some unidentified molecule be responsible for the health risks? To many, the claim that bioidentical hormones are safer because they have the same chemical structure as those produced by our own bodies would seem plausible. Yet there's no good evidence to support this claim.
Although bioidentical progesterone and the bioidentical estrogen estradiol have been approved, they haven't been studied in large, long-term trials. They're FDA-approved because they've been shown in trials to relieve menopausal symptoms and reduce the risk of osteoporosis. These claims are allowed on their packaging. And similar to other FDA approved estrogens and progestogens, these bioidenticals also carry black box warnings. Hormones from compounding pharmacies, which aren't FDA-approved, don't come with package inserts bearing the black box warning, giving the illusion of being safer than commercially marketed drugs.
But the lack of a warning doesn't mean they're safer, only that compounding pharmacies aren't required to detail potential risks. To date, hormones from compounding pharmacies haven't been tested in clinical trials. Until then, the risks associated with them cannot be fully known.
Finally, while compounding pharmacies are regulated by state pharmacy boards, they're not required — as manufacturers of approved drugs are — to report on side effects or other adverse outcomes from their products. There actually may not be much difference between an FDA-approved bioidentical and the custom-compounded version. Both are made from the same hormones and manufactured according to the requirements of the United States Pharmacopeia a nongovernmental authority that sets standards for prescription and over-the-counter drugs. At a compounding pharmacy, hormones are placed in a capsule, gel, cream, suppository, or other vehicle.
A pharmaceutical company follows the same procedure, but it must use a standard dose in a specific vehicle because the two have been tested and approved as a unit. In this respect, an FDA-approved bioidentical may be more reliable. Disclaimer: As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Please note the date of last review on all articles.