Hormone Replacement Therapy And Ovarian Cancer

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Hormone Replacement Therapy And Ovarian Cancer

Since the early 1990's, doctors have prescribed synthetic hormones to older women in order to alleviate symptoms associated with menopause, such as hot flashes, night sweats, sleeplessness, and vaginal dryness. These symptoms occur as the body adjusts to decreased levels of estrogen. Hormone replacement therapy (HRT) can mean either taking estrogen alone or taking estrogen plus progesterone or progestin, a synthetic hormone with effects similar to those of progesterone. These two hormones are involved in regulating a woman's menstrual cycle.

Estrogen therapy alone is usually prescribed only for women who have had a hysterectomy. Progestin prevents the overgrowth of cells in the lining of the uterus, which can lead to uterine cancer. In contrast, estrogen plus progestin is typically recommended for women with an intact uterus. Hormones may be taken daily ("continuous" therapy) or on only certain days of the month ("sequential" therapy). Over the past decade, several studies have reported an increased risk of ovarian cancer with the long-term use of HRT.

In a study published in 2006 from the National Cancer Institute (NCI), five or more years of estrogen plus progestin use significantly increased the risk of ovarian cancer for women who had not had a hysterectomy. James V. Lacey, Jr., Ph.D. of the Hormonal and Reproductive Epidemiology Branch of the NCI and his team estimated relative risks of ovarian •cancer after exposure to HRT in almost 100,000 women 50 to 71 years of age.

The use of unopposed estrogen (estrogen alone) for less than 10 years was not associated with ovarian cancer, but the NCI team concluded that the use of unopposed estrogen and of estrogen plus progestin for long durations, especially sequential regimens, was associated with an increased risk. Women who had used estrogen plus progestin for a long period also had increased risks of ovarian cancer compared with women who had not used HRT.

(Source: Journal of the National Cancer Institute, 2006;98: 1397-1405.)

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