Should women use hormone replacement therapy during menopause?

The article was written by doctors of Internal Oncology - Vinmec Times City International General Hospital.

Hormone replacement therapy is a term for women entering menopause who have taken more female hormone drugs, this will help them retain their youthful features like when they were menstruating. some symptoms of menopause such as hot flashes, nervousness, sweating...

Using data from more than 100,000 women with breast cancer in 58 epidemiological studies worldwide, researchers have shown that hormone therapy is associated with an increased risk of cancer. breast.
Additionally, research published in The Lancet suggests this increased risk may persist for more than 10 years after cessation of hormone replacement therapy. The use of hormone replacement therapy in western countries has caused about 1 million cases of breast cancer, out of a total of about 20 million cases since 1990, say Breast Cancer researchers.
To estimate the risks, researchers analyzed data from all studies published between 1992 and 2018 that looked at the type and duration of hormone replacement therapy use.
Of the postmenopausal women included in the studies, 108,647 were diagnosed with breast cancer. About half (51%) use hormone replacement therapy. Among current users, the average duration of use was 10 years, and 7 years for former users. The average age of starting hormone replacement therapy is 50 years old.
Results from the study show that all types of hormone replacement therapy, with the exception of vaginal estrogen, are associated with an increased risk of breast cancer. An increased risk of breast cancer was seen during years 1 to 4 of use (estrogen-progestagen RR = 1.60, 95% CI 1.52-1.69; estrogen RR = 1.17, 1.10 - 1.26) and doubled between 5 and 14 years (estrogen -progestagen RR = 2.08, 2.02-2.15; estrogen RR = 1.33, 1.28 - 1.37).
For women aged 50 to 69 years with 5 years of primary hormone replacement therapy, the risk of breast cancer increased not only during the 5 years of use but also during the following 15 years after stopping use .

According to Gillian Reeves, from the University of Oxford, UK: “Using hormone replacement therapy for 10 years doubles the risk of breast cancer compared to 5 years of use. However, there is very little risk if only using hormone replacement therapy for less than a year, or using only vaginal oestrogen in the form of a cream..."
According to research by scientists, it will be difficult to avoid biases in retrospective studies where the duration of exposure (using hormone replacement therapy) overlaps with the risk period (incidence of breast cancer). Therefore, it is also important for clinicians to take a rational and holistic approach to the management of menopausal symptoms, weighing the risks and benefits of initiation for each woman.
JoAnn Manson, MD, Dr, of Brigham and Women's Hospital in Boston, also emphasizes the importance of shared decision making between doctors and patients. “Women need to be informed about both the risks and the benefits so that they can make informed choices.”
This means that doctors and patients should assess the severity of menopausal symptoms and potential risk factors for breast cancer. For example, if the patient has moderate to severe hot flashes, night sweats and a family history of breast cancer and is concerned about her risk, it may not be appropriate and other options should be considered. opting for a non-hormonal option for her menopause symptoms.

According to Dr. Manson, breast cancer risk does not need to be considered independently, because scientists found that “HRT may increase breast cancer risk, but is associated with increased risk of breast cancer. reduced risk of colorectal cancer and endometrial cancer in a number of other studies. This highlights the need for individual decision making, because in some cases the overall benefits of hormone replacement therapy can be promising.
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