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Despite cancer risk, some need hormones

This week's news that a big drop in breast cancer cases might be due to millions of women going off menopause hormones may lead even more of them to abandon the pills.
/ Source: The Associated Press

This week's news that a big drop in breast cancer cases might be due to millions of women going off menopause hormones may lead even more of them to abandon the pills.

But doctors worry that women with severe menopausal symptoms will overreact to the risks and deny themselves the benefits of hormones.

"There are some women who really require treatment. ... I worry that they will be talked out of it," said Dr. JoAnn Manson, a women's health expert at Harvard-affiliated Brigham and Women's Hospital in Boston.

Hormone use plummeted after a 2002 study found that it raised the risk of breast cancer, heart disease and other problems. Before that, the pills were thought to prevent many of those conditions, and doctors prescribed them as little fountains of youth.

On Thursday, researchers reported that the rate of breast cancer in the United States dropped more than 7 percent in 2003, the year after that landmark study. The backlash against hormones is considered the leading explanation for the decline.

Some women are still using hormone therapy "because their doctors genuinely believe that it prevents some diseases," said Dr. Isaac Schiff of Massachusetts General Hospital, who headed a panel for the American College of Obstetricians and Gynecologists that recommended in 2004 that doctors not withhold the treatment from women who truly need it.

But that's not as many women as you might think, Manson said.

About 2 million women start menopause each year in the United States, but only about one-fourth have moderate to severe symptoms lasting longer than four years, said Manson, whose new book, "Hot Flashes, Hormones & Your Health," includes a flowchart to help women decide whether to use hormones, which type and for how long.

Weighing the risks
The key questions a woman should weigh:

  • Am I already at risk of heart disease, blood clots or breast cancer that would make hormones a bad idea?
  • Are my symptoms truly disrupting my life?

One thing doctors agree on about hormone therapy: It works.

Nancy Nixon used it for six years to treat headaches, night sweats and hot flashes until she was diagnosed with breast cancer 11 years ago.

"It does make me feel sad" to no longer be able to use it, said Nixon, who manages the call-in line for Y-ME, a cancer support group. "But if someone said to me, 'Chocolate causes breast cancer,' I would stop eating it even though I love it."

Schiff said that when he tells patients of the potential breast cancer risk, "some go into a panic and say, 'I'll just suffer.'"

Manson called that unfortunate.

"There are ways to reap those benefits and minimize the risk," she said.

Tips on taking hormones
She and the gynecology group offer these suggestions:

  • Take the lowest dose for the shortest time — two or three years if possible. Start out small and add more medication if symptoms do not abate.
  • Do not take hormones to try to prevent heart disease; they don't.
  • Never take estrogen without progestin if you still have a uterus because that raises the risk of uterine cancer.
  • Try periodically to cut your dose and wean yourself off.

"It's important that women do try to discontinue," and not just stay on the pills for many years, Manson said.