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Progesterone

Question: Does progesterone (progestin) in hormone replacement therapy (HRT) cause breast cancer?

Answer: In hormone replacement therapy (HRT), hormones are taken to replenish the natural ones (estrogen or progesterone) that decrease with menopause. Estrogen can be taken alone or with progesterone. Recent studies suggest an increased risk of breast cancer for women taking HRT for 5 years or longer. This risk is greater for women who take both estrogen and progesterone, compared with women who take only estrogen. The risk returns to the same as nonusers 5 years after HRT is stopped. The benefits and risks of HRT are still being debated. Besides countering some of the effects of menopause (hot flashes, sleepiness, and vaginal dryness), HRT helps prevent osteoporosis (loss of bone mass) and may also reduce the risk of heart disease. If you are interested in HRT and worried about its side effects, talk to your doctor.

Question: After I went through menopause, my doctor told me to take both estrogen and progesterone pills. Why can't I take just estrogen?

Answer: After menopause, many women begin hormone replacement therapy (HRT), which helps maintain bone strength (to reduce the risk of fracture, and lowers the level of low-density lipoprotein ("bad") cholesterol in the blood. HRT also helps relieve many of the uncomfortable symptoms of menopause, like hot flashes.

But HRT medications come with some risks. One of the most worrisome effects of HRT is a possible increase in the risk of cancer--specifically, cancer of the lining of the uterus (endometrial cancer). Women who take the hormone estrogen without progesterone have a higher risk for endometrial cancer than women who don't take HRT therapy at all.

Fortunately, by taking estrogen and progesterone together, the risk may be eliminated.

Women who have had surgery to remove their uterus (a hysterectomy) cannot develop endometrial cancer, so they may safely take estrogen without progesterone.

It is important to discuss your risk of cancer with your doctor and to consider the benefits and risks of hormone replacement therapy before starting this medication.

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