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New comprehensive study demonstrates safety of estrogen therapy for women post-hysterectomy; combination therapy (estrogen + progesterone) found to be a higher risk for breast cancer than previously estimated
Finding relief from menopause symptoms can be fraught with worry due to conflicting information about the risks of hormone replacement therapy (HRT). However, in a new, comprehensive study by scientists at the Institute of Cancer Research in London that followed 39,000 women on hormone therapy for 6 years, the results are clear.
Estrogen-only therapy showed no overall increase in breast cancer risk compared with women who had never used HRT. This type of therapy can be safely prescribed to women who no longer have a uterus. However, those using combined HRT, a combination of estrogen and progestogen, had a 2.7 times greater risk than non-users, significantly higher than previously reported. This is the type of hormone therapy that can be prescribed to women who have not had a hysterectomy. Estrogen-only therapy can negatively affect the uterus and requires progesterone to balance out the effects. Estrogen therapy alone can increase the risk of uterine cancer.
The implications for women who have GYN conditions that would benefit from a minimally invasive hysterectomy are now two-fold. In addition to treating a condition like fibroids, or adenomyosis, a hysterectomy opens a woman up to a safer form of HRT when she reaches menopause. Hormone therapy can alleviate the often life- altering symptoms of menopause, including hot flashes, night sweats, mood swings and vaginal atrophy, while reaping the benefits of a decreased risk of colorectal, lung, and breast cancers, coronary heart disease, pulmonary embolism or stroke.
“For many women, menopause symptoms are incredibly disruptive to their lives so that the benefits of hormone replacement therapy often outweigh the risks, but it is important to understand how we as medical professionals can further advise based on the results of these studies,” said Dr. Paul MacKoul, MD. “These findings make a strong case for the safe use of estrogen therapy after hysterectomy for relief of menopausal symptoms. This is an important factor for older women with fibroids who often believe a myomectomy is a preferable and less invasive procedure than a hysterectomy, which isn’t true.”
“Taking the fear and stigma out of having a hysterectomy is important for medical professionals to work through with patients,” said Dr. Natalya Danilyants, MD. “Once a woman is past childbearing, if she is suffering with a GYN condition like large fibroids, a hysterectomy performed with the minimally invasive DualPortGYN technique has exceptional results, and will eliminate the need for the higher risk combination hormone therapy once she enters menopause. She can live a healthier, symptom free life. It’s important to take the patient’s wishes into account when discussing treatment options, but it’s equally important for the patient to have all of the facts. These new findings are an important tool for women to make better choices about their health.“
Dr. Paul MacKoul, MD and Dr. Natalya E. Danilyants, MD are minimally invasive GYN specialists who developed the DualPortGYN and LAAM techniques used at The Center for Innovative GYN Care. These advanced techniques allow women with complex conditions like large fibroids, extensive endometriosis, adenomyosis, and pelvic adhesions to have outpatient procedures with fast recovery.