Hormone Replacement With Estrogen/Progestogen Combo Increases Breast Cancer Risk More Than Once Thought
A 2016 article in the British Journal of Cancer suggests that previous studies underestimated breast cancer risk in women who received hormone replacement therapy with the combination of estrogen and progestogen. The article by researcher Michael E. Jones and colleagues reported that combined hormone replacement therapy could increase the risk of breast cancer by more than three times, depending on how long a woman is exposed to the therapy. The longer the duration of use, the greater the risk of breast cancer. In the study, women who used other types of hormone replacement therapy, such as estrogen only or tibolone, did not have drastically higher rates of breast cancer than had been reported before.
Jones and colleagues suggest that previous studies did not use long enough follow-up periods to track whether women developed breast cancer while using hormone replacement. Their own study is based on a United Kingdom dataset known as the Breakthrough Generations Study. Study participants completed questionnaires at 2.5 years after recruitment, again at around 6 years, and again around 9.5 years. At the time of recruitment, women using combination hormone replacement therapy had been doing so for a median of 5.5 years.
Women who used combination hormone replacement therapy for 5.4 years were 2.74 times likelier to have breast cancer than those who didn’t receive hormone replacement. Using the combined therapy for more than 15 years increased risk 3.27 times compared to non-users.
The study also reported that as body mass index increased, breast cancer risk increased, regardless of hormone use.
While the study by Jones and colleagues was large (39,183 participants), the number of women who took combined hormone replacement and developed breast cancer was still fairly small (52). Seven of the 52 had taken the combined pill for more than 15 years. One limitation of this study is that these seven women may have skewed the risk assessments somewhat.
Experts suggest that women balance the possible risks and benefits of hormone replacement therapy. The therapy can be helpful in reducing symptoms of menopause, particularly hot flashes.
Using the lowest effective dose for the shortest time possible may be the best option. The increased risk of breast cancer drops after a woman stops using hormone replacement.
Depression More Likely Among Perimenopausal Women with Bipolar Disorder
Researchers found that among women with bipolar disorder, those in the menopausal transition period were significantly more likely to be depressed than premenopausal women in the sample, and that the increased proclivity for depression continued in post-menopausal women as well. Wendy Marsh, Terrence Ketter, Sybil Crawford, Julia Johnson and Anthony Rothschild studied 521 women of reproductive age, 107 women in the menopausal transition period, and 145 post-menopausal women in a multi-site treatment enhancement program for bipolar disorder (STEP-BD).
The women of reproductive age ranged from 28-38 years old, and the women in the menopausal transition period averaged 42 years old and 365 days past their last menstrual period.
Women in the menopausal transition were less likely to experience a manic episode compared with reproductive aged women, and those who were post-menopausal had the least likelihood of experiencing a manic episode. These data are consistent with others in the literature that suggest that the menopausal transition may be associated with an increased proclivity to depressive episodes.
These data also raise the question of whether hormone replacement therapy in the late menopausal transition phase may be a useful adjunct for treatment-resistant depression.
