You Asked, We Answered: Questions About Hormone Therapy and Cancer

Dr. JoAnn Manson is one of the authors of a study on the cancer risks of hormone replacement therapy.

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Manson is chief of the Division of Preventive Medicine at Brigham and Women's Hospital and Elizabeth F. Brigham professor of women's health at Harvard Medical School.

Cecilia from Utica, N.Y., asked: "I am now taking Climara Pro patch. Does it have the same risks as traditional hormone replacement therapy?"

Manson: There's mounting evidence that estrogen patches may be less likely to increase the risks of blood clots in the legs and lungs than estrogen in pill form. However, this evidence is not yet conclusive and decisions about pills versus patches often depend on a woman's personal preference. Many women report that estrogen pills are easier to use and patches can occasionally cause skin irritation. Estrogen pills are also better than patches at improving cholesterol levels. However, pills may be more likely than patches to increase blood clots, triglycerides, and markers of inflammation. Knowing about these differences can help you and your doctor choose the therapy type that's best for you. Keep in mind that there are no large-scale rigorous studies comparing the patch versus the pill in terms of heart safety, breast cancer risk and other health outcomes.

Susan from Westfield, N.J., asked: "I am aware of the dangers of traditional hormone therapy. However, my doctor has recommended natural hormone replacement by using hormones compounded specifically for me based on blood tests done every six months.

"Does this type of hormone therapy carry the same risks as the traditional 'one size fits all' therapy? My doctor says it does not and she herself takes compounded hormones."

Manson:"Bioidentical" hormones are a molecular match to the estrogen or progesterone made naturally by our bodies. Proponents of bioidentical hormone therapy (BHT) claim that these products have fewer risks than traditional hormone therapy, but the reality is that few rigorous studies of these medications have been done and it's unknown whether they're any safer or more effective.

Bioidenticals can be purchased at conventional pharmacies in a range of set doses or at compounding pharmacies in "customized" doses. If you'd like to try bioidenticals, it may be best to stick with commercial preparations, which are regulated by the FDA, rather than custom-mixed ones, which aren't (unless you have an allergy to an ingredient or another clear reason to avoid the commercial preparations). Quality control, in terms of ensuring consistency of dose and purity (lack of contamination) is better with the FDA-approved medications. Also, there's no evidence that blood or saliva testing of hormone levels is helpful in adjusting or "balancing" the dosages of estrogen or progesterone.

Pam from Indianapolis asked: "Keeping all the studies in mind, what can someone do who is just beginning to feel the first symptoms of menopause? Should HRT be avoided from the very beginning? Do the risks outweigh the benefits? And are there any alternative therapies with merit? Thank you!"

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