Download Hormone Replacement Therapy

Breast Service
Hormone Replacement
Therapy
Information
Hormone Replacement Therapy (HRT) is used to treat symptoms
of the menopause when –
 a woman’s ovaries no longer produce female hormones,
known as oestrogen and progesterone
 when the ovaries have been surgically removed.
HRT may be given as patches for the skin, tablets, a cream or
gel. Preparations contain either oestrogen alone (oestrogen-only
HRT) or both oestrogen and progesterone (combined HRT).
Tibolone is another type of HRT that contains a steroid that acts
like oestrogen and progesterone.
Oestrogen-only HRT can increase the risk of womb (endometrial)
cancer, whereas combined HRT does not. If you have not had a
hysterectomy, you will usually be prescribed combined HRT to
protect your womb. If you have had a hysterectomy, you are not
at risk of womb cancer, so will usually be prescribed oestrogen
only HRT.
In addition to reducing menopausal symptoms, HRT may also be
used to prevent osteoporosis (where bones lose their strength
and become fragile), especially if menopause has taken place
before the age of 45.
Women who enter the menopause at a young age may be given
HRT up to the age of 50 without increasing their risk of breast
cancer. The Institute for Cancer Research also recommends HRT
following surgical removal of the ovaries until a woman is 50
years of age, unless there is a specific reason why she cannot
take HRT.
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HRT and Increased Risk of Breast Cancer
Both oestrogen-only and combined HRT slightly increase the risk
of breast cancer. The risk associated with oestrogen-only HRT is
less than that with combined HRT. It is unclear to what degree
Tibolone increases breast cancer risk, but it is thought to lie
somewhere between the risks associated with oestrogen–only
and combined HRT.
This risk increases the longer HRT is used. Short-term use (less
than 5 years) is likely to have only a small effect on breast cancer
risk.
The increased risk begins to fall as soon as HRT is stopped, and
within 5 years of stopping HRT, a woman’s chance of developing
breast cancer is the same as if she had never taken HRT.
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Age of Women
HRT Status
50 - 59
No
HRT
In a 1000 women the
number who will develop
Breast Cancer over a 5
year period
In a 1000 women the
number who will develop
Breast Cancer over a10
year period
Age of Women
HRT Status
10
2 extra cases
20
6 extra cases
In a 1000 women the
number who will develop
Breast Cancer over 5
years
In a 1000 women the
number who will develop
Breast Cancer over a 10
year period
15
3 extra
cases
Combined
Oestrogen
and
progesteron
e HRT
(estimated)
9 extra
cases
30
9 extra
cases
36 extra
cases
60-69
No HRT
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Oestrogen
Only HRT
(estimated)
Oestrogen
Only HRT
(estimated)
Combined
Oestrogen
and
progesterone
HRT
(estimated)
6 extra cases
24 extra
cases
Taking HRT may increase the density of the breast, increasing
the amount of glandular and supportive tissue compared to fat,
which can make it more difficult to identify breast cancers on the
mammogram.
Other risks and benefits of HRT
HRT offers many women relief from menopausal symptoms and
can significantly improve their quality of life. It also reduces the
risk of bone fractures and the possibility of bowel cancer.
However, as well as increasing the risk of breast cancer, both
oestrogen-only and combined HRT may increase the risk of
ischaemic heart disease (angina and heart attacks), blood clots
on the lungs (pulmonary emboli) and stroke. These risks will also
be dependent on other factors, such as a woman’s age and
medical history.
Having a Diagnosis of Breast Cancer
About 75% of breast cancers are sensitive to oestrogen
(oestrogen receptor or ER positive). This means that the body’s
own naturally produced oestrogen or additional oestrogen taken
as HRT may stimulate growth of cancer cells.
We routinely test breast cancer tissue to see if the individual cells
are receptive to the effects of oestrogen and or progesterone. If
this test shows that the cancer is ER positive, most women will be
prescribed medication such as tamoxifen or an aromatase
inhibitor (anastrazole, letrozole or exemestane). These work by
blocking oestrogen receptors (tamoxifen) or reducing the amount
of oestrogen produced (aromastase inhibitors).
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These medications are a very effective way to reduce the risk of
the cancer coming back, not only in the breast but also anywhere
else in the body.
Using HRT whilst on these medications is never advised, as the
oestrogen contained in the HRT directly counteracts the effects of
hormone blockade.
It is not clear whether any type of HRT is safe for women who
have had breast cancer as there is no substantial research to
support the use of HRT, after any time interval, following breast
cancer treatment.
Relief of menopausal symptoms poses a real dilemma for women
successfully treated for breast cancer, particularly as many of the
treatments can bring on early menopause.
In the first instance, your medical team will recommend trying an
alternative to HRT if menopausal symptoms are severe. This may
include:
Self-help measures such as:
 alterations to diet
 weight management
 life style changes
 exercise and relaxation
If self-help measures fail to work, your GP may consider
prescribing Non hormonal medications.
Women who have had breast cancer are not usually prescribed
HRT, but some specialists will prescribe it on a case-by-case
basis, having considered all the risks and benefits.
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Contact Information
If you have any questions or concerns after reading this leaflet,
please do not hesitate to contact the Clinical Nurse Specialist or
one of the Breast Care Nurses.
 01536 492532/3
Monday to Friday
9am to 4.40pm
References
www.mhra.gov.uk/drugsafetyupdate Drug Safety Update 2007:1
(2): 2-6
Hormone Replacement Therapy and Breast Imaging: A Review
http://www.eradimaging.com/site/article.cfm?ID=790
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If you need this information in another format or language, please
telephone 01536 492510.
Further information about the Trust is available on the
following websites:
KGH - www.kgh.nhs.uk | NHS Choices - www.nhs.uk
Ref: PI 967 October 2015
Next review: July 2017