Effects of Early Menopause From Cancer Treatment May Be Eased With Hormone Replacement Therapy

Hormone replacement therapy in women with early and premature menopause may reduce early mortality rates, heart disease, stroke, cognitive impairment and dementia, according to an expert.

Of note, hormone replacement therapy does not reduce the risk of anxiety, depression or early-onset of Parkinson’s disease, which are all possible side effects of early and premature menopause.

“The term hormone replacement therapy should be reserved for women experiencing premature or early menopause. Hormone therapy is the term we use for hormone therapy in older women who go through natural menopause. And the difference is that in hormone replacement therapy, we are actually physiologically replacing the estrogen to reduce some of the side effects of early aging. And in older women, we're giving hormone therapy simply to medicate menopausal symptoms,” Dr. Ann L. Steiner, director and founder of the Menopause Clinic at Penn Medicine in Philadelphia, explained during her presentation at the 12th Annual Joining Forces Against Hereditary Cancer Conference.

Steiner emphasized that there are no current studies that demonstrate an increased risk of breast cancer or peritoneal cancer with hormone replacement therapy. She said, “The risk-benefit balance is definitely in favor of (hormone replacement therapy) prior to the age of 50 or 51.”

Steiner noted one study that compared women who were pre-menopausal versus post-menopausal. Through the published data, it was found that in post-menopausal women, regardless of age, there was a higher incidence of cardiovascular disease. It was also found that those women who underwent a bilateral salpingo-oophorectomy (a surgery that removes both ovaries and the fallopian tubes) before age 45, there was no increased risk of heart disease if they were treated with hormone replacement therapy.

According to Steiner, women who go through menopause also experience a gradual decrease of bone mineral density. “In women who undergo surgical menopause early on, there's a very rapid decline of their bone mineral density, and the reason is that they lose their estrogen very quickly,” she explained. “All of these groups of women, by the time they're 65 years old, have the same bone mineral density on average and the same risk of fracture, but it's during this period of time that these younger women who have early loss of estrogen are at increased risk of fracture.”

Women who go through menopause before the age of 45 years, Steiner said, are at a three times higher risk for any fracture compared to women who undergo menopause later in life. “The incidence of hip fracture for these young women can be as much as 6% higher compared to older women going through menopause. The risk for a spine fracture is two-and-a-half times greater in these young women. And in women at elevated risk of fracture, based on their age, significant reductions in fracture risk have been described with the use of hormone replacement therapy,” she explained.

While the exact dosage and best way of giving hormone replacement therapy is still unknown, Steiner emphasized, “Women who have premature early menopause have increased morbidity and mortality. Hormone replacement therapy is an effective approach to treating the symptoms of low estrogen and can mitigate long-term health risks but should only be given if there are no contraindications to hormone therapy. For women who simply have menopausal symptoms such as hot flashes, we would offer nonhormonal treatment first, and also in the prevention of osteoporosis.”

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