The safety of both short-term and long-term HRT use is now under intense scrutiny by the federal government — scrutiny triggered by major studies of HRT published in 2002. One of those studies, part of the Women’s Health Initiative (WHI) — one of the largest studies of women’s health ever undertaken and still under way — investigated the use of combination estrogen-progestin hormone therapy for the prevention of coronary heart disease on healthy women between the ages of 50 to 79 years.
In January 2003, the U.S. Food and Drug Administration (FDA) announced that it would require a new, highlighted “black-box” warning on all estrogen products for use by post-menopausal women. The warning suggests an increased risk for heart disease, heart attacks, stroke and breast cancer from supplemental estrogen — risks illuminated by part of the WHI study, which was abruptly halted when the risks were identified.
Also emphasized by the "black-box" warning is that estrogen products are not approved for heart disease prevention. It advises health care professionals to prescribe estrogen products at the lowest dose and for the shortest possible length of time.
Discuss your questions about ERT and HRT use with your health care professional with your personal health needs and health history in mind.
- Late menopause: Women who have a later menopause have a slightly increased risk of developing uterine cancer.
- Nonpolyposis colorectal cancer: Women with or at risk for hereditary nonpolyposis colorectal cancer have an increased risk for developing uterine cancer and annual screenings should be offered with endometrial biopsy beginning at age 35.
Another factor to consider is race. For reasons that are not entirely clear, uterine cancer is approximately twice as common in Caucasians as it is in African Americans and other non-Caucasians. On the other hand, African Americans who get this type of cancer are more likely to die of their disease.
Also, several studies have shown that the breast cancer drug Tamoxifen significantly increases the risk of uterine cancer, but it is not associated with an increase in mortality from uterine cancer. However, it is believed that the lowered incidence of breast cancer deaths when taking this drug outweighs the risk of developing uterine cancer. If you are receiving Tamoxifen, you do not need routine x-rays or biopsies, but should be examined by your gynecologist at least once a year or right away if irregular bleeding occurs.
Although decisions regarding contraception and family planning are complex, you should be aware that bearing children decreases the risk of developing both uterine and ovarian cancer.
So, how can you take care of yourself? Women who are at risk for uterine cancer need to monitor their health closely. You should report any abnormal bleeding to your health care professional immediately and have regular check-ups. Early diagnosis and treatment are key to recovery from uterine cancer.