Menopause hormone therapy and cancer risk

Menopausal hormone therapy is considered a way to help relieve uncomfortable symptoms after menopause. However, studies show that hormone therapy increases the risk of various types of cancer, typically endometrial cancer, breast cancer, ovarian cancer, and colorectal cancer.

Menopause is a time in a woman's life when the ovaries stop working and menstruation stops. The ovaries no longer release eggs and the female hormones, estrogen and progesterone. In the months or years leading up to menopause, periods may be less frequent and irregular, and hormone levels often fluctuate. This time is called perimenopause.
Low estrogen levels are responsible for most of the symptoms of menopause, such as hot flashes, osteoporosis, night sweats, vaginal tissue becoming dry and thinner. To ease a woman's discomfort during menopause, her doctor may advise taking certain hormones through hormone replacement therapy.

The hormones commonly used to treat problems during menopause are estrogen and progesterone (where progesterone and similarly active drugs are collectively known as progestins). Usually, these two hormones are used together, but in some cases your doctor may prescribe estrogen alone.
Male androgens (such as testosterone) are also sometimes used to treat menopausal symptoms. However, this is not common and there are currently only a few studies that support this, so its long-term safety is unknown.
2.1. Using estrogen plus progestin versus estrogen alone Treating menopausal symptoms with estrogen plus progestin is called estrogen-progestin therapy (EPT) or combined hormone therapy. While estrogen alone can improve uncomfortable symptoms of menopause, it increases the risk of endometrial cancer. Combining a progestin with an estrogen helps reduce this risk. Therefore, EPT is usually indicated for women who still have a uterus (who have not previously had a hysterectomy). EPT can be given in 2 ways:
Continuous EPT: Using the same dose of estrogen and progestin every day. Most women prefer this type of treatment because it rarely leads to menstrual-like bleeding. Sequential (cyclical) EPT: Different doses of the hormone are administered on specific days in a given cycle. There are different ways to build a cycle, for example, estrogen alone can be taken for 14 days, followed by a combination of estrogen and progestin for 11 days, followed by 3-5 days without use hormones. Usually, progestin is prescribed every few months to reduce the amount of progestin absorbed. Sequential EPT cycles lead to changes in hormone levels in the body similar to the natural menstrual cycle. Accordingly, women on hormone therapy often have bleeding like in the menstrual cycle, but this will happen less each month. 2.2. Bio-identical hormones Bio-identical hormones are believed to contain estrogen and progesterone with a chemical structure similar to the natural hormones secreted by a woman's body. Sometimes hormone levels are adjusted based on blood test results for hormone levels.
Although bioidentical hormones are structurally similar to human hormones, to date, there have been no long-term studies on the safety of bioidentical hormones and no studies showing them The use of biological hormones will have less serious side effects than other forms of hormones. For this reason, biogenic hormones are thought to pose the same health risks as any other type of hormone therapy.
2.3. Estrogen therapy (ET) Therapy for the symptoms of menopause with estrogen alone is called estrogen therapy (ET). ET helps improve the uncomfortable symptoms of menopause but also increases the risk of endometrial cancer. Therefore, ET is only safe for women who have had a previous hysterectomy.

Several large studies have looked at possible links between menopausal hormone therapy and the risk of different types of cancer.
3.1. Estrogen-progestin therapy (EPT) and cancer risk Endometrial cancer Studies have shown that EPT does not increase the risk of endometrial cancer. However, if you have vaginal bleeding after menopause, it could be a symptom of cancer in the lining of your uterus.
Breast cancer EPT use is associated with an increased risk of breast cancer . The longer EPT is used, the higher the risk. This risk usually goes away 3 years after stopping menopausal hormone therapy. Breast cancers in women taking EPT are usually found when they begin to progress and spread beyond the breast.
According to risk estimates, with 10,000 women taking EPT for a year there will be about 8 more cases of breast cancer per year than if they didn't take hormone therapy. EPT is also associated with increased breast tissue density (on mammograms). Increased breast density can make detecting breast cancer more difficult.
Ovarian cancer Risk factors for ovarian cancer are often difficult to study because it is a less common type of cancer. Even though menopausal hormone therapy increases the risk of ovarian cancer, the actual incidence is still quite low.
An analysis that combined the results of more than 50 studies found that women who took estrogen and progestin (progesterone) after menopause had an increased risk of ovarian cancer. The risk of cancer is highest during hormone use and decreases over time after stopping treatment. On average, for every 1000 women 50 years old who take hormones after menopause for 5 years, one more patient will be diagnosed with ovarian cancer.
Colorectal cancer Women taking EPT have a lower risk of colorectal cancer, but disease progression is often more severe (more likely to spread to lymph nodes or distant organs) than for those not taking menopausal hormone therapy.
Lung cancer EPT does not increase the risk of lung cancer , however research shows that EPT is associated with higher lung cancer mortality complications than those without treatment.
3.2. Estrogen therapy (ET) and cancer risk Endometrial cancer Systemic use of ET has been shown to increase the risk of endometrial cancer (except in cases of hysterectomy). ). The risk remained above average even after the drug was discontinued.
Because of the increased risk of cancer, women who have gone through menopause and still have a uterus should be treated with a progestin plus estrogen (EPT therapy). Studies show that EPT does not increase the risk of endometrial cancer as with ET. In addition, long-term use of vaginal creams, rings, or tablets containing estrogen doses (topical use) can also increase systemic estrogen levels. However, the amount of this hormone is much smaller than with systemic menopausal hormone therapies, and it is not clear whether this poses health risks.
Breast cancer ET does not increase the risk of breast cancer . In fact, according to research, certain groups of women taking estrogen alone, such as women with no family history of breast cancer and those without a history of benign breast disease, have an increased risk of cancer. lower breasts compared to those not on menopausal hormone therapy.
Ovarian cancer Similar to EPT, an analysis that combined the results of more than 50 studies found that women who took estrogen alone after menopause had an increased risk of ovarian cancer. The risk of cancer is highest during hormone use and decreases over time after stopping treatment. On average, for every 1000 women 50 years old who take hormones after menopause for 5 years, one more patient will be diagnosed with ovarian cancer.
Many observational studies have shown that women who take ET have a higher risk of ovarian cancer than women who do not take menopausal hormone therapy. Overall risk remains low, but increases with long-term ET use. The risk of ovarian cancer decreases after stopping hormone therapy.
Colorectal cancer According to research, ET does not seem to have any effect on the risk of colorectal cancer, even lower incidence among women who have used ET for many years.

When prescribing menopausal hormone therapy, estrogen alone (ET) or in combination with a progestin (EPT), the physician should weigh the risks and benefits and discuss this with the person being treated. treat. Considerations include:
A woman's pre-existing risk for breast cancer, endometrial cancer, ovarian cancer and other cancers, as well as the extent to which the disease is affected by menopausal hormone therapy. Risks are caused by other conditions that are affected by hormone therapy but not covered in this article, such as heart disease, stroke, blood clots, or conditions that affect the brain. What other medicines can be used to treat menopausal symptoms or osteoporosis? Also, consider how severe a woman's menopausal symptoms are, and the type and dose of hormones needed to work.

In case your doctor thinks that menopausal hormone therapy is the best way to treat symptoms or problems caused by menopause, remember that the essence of therapy is the use of medication. As with any other medication, it's best to use it at the lowest dose needed for the shortest time possible and strictly follow your doctor's orders. In addition, you need to have regular check-ups so that your doctor can evaluate the effectiveness of your treatment, monitor side effects, and what to watch out for while taking the drug.
When you notice vaginal bleeding occurring during menopausal hormone therapy, notify your doctor immediately as it could be a symptom of endometrial cancer. Although EPT does not pose a high risk of causing endometrial cancer, women in general can develop it with pre-existing risk factors.
The use of vaginal creams, rings or tablets containing the hormone estrogen should be discussed in advance with a doctor to be monitored and consider adding a progestin.
For women who have had a hysterectomy, a progestin is not necessarily present in menopausal hormone therapy because it is nearly impossible for them to get endometrial cancer. Furthermore, adding a progestin to the treatment regimen increases the risk of breast cancer. Therefore, ET is a better choice for someone who has had a hysterectomy.
Before and during menopausal hormone therapy, you need to follow your doctor's instructions for early detection and screening for cancer, especially breast cancer.
In order to help customers detect and treat early diseases prone to menopause, Vinmec International General Hospital has a basic gynecological examination and screening package, helping customers detect diseases early. Inflammatory diseases make treatment easy and inexpensive. Screening detects gynecological cancers early (cervical cancer, ovarian cancer) even when there are no symptoms.
Basic gynecological examination and screening package for customers who are women, at risk of disease or women in menopause and perimenopause. The package is not age-restricted and may have the following symptoms:
Abnormal vaginal bleeding Menstrual problems: irregular periods, irregular periods Abnormal vaginal discharge (yes) bad smell, different color) Pain, itching in the private area Female customers have several risk factors such as poor personal hygiene, unsafe sex, abortion,... Female customers Have other symptoms such as: Abnormal vaginal discharge, itching, pain in the vagina, abnormal vaginal bleeding. All examination procedures are always performed by a team of highly qualified doctors with many years of experience, so customers can be assured of the medical quality at Vinmec.

References: cancer.org - cancerresearchuk.org - thelancet.com