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HRT: Duration of HRT

Duration of HRT

Current recommendations are that there should be no arbitrary limits for use of HRT--women can take it for as long as they feel that it is beneficial to them.
Many women have been advised to stop HRT because of concern about risk of breast cancer. However, it should be noted that the association of any HRT and breast risk is very small. Estrogen only HRT is thought to be associated with little or no increased risk of being diagnosed with breast cancer. Estrogen combined with progestogen may be associated with a small increased risk of being diagnosed if taken for more than 5 years after the age of 50, (approximately extra 4 cases per 1000 women aged 50-59 over 5 years) but these extra are thought to be due to HRT promoting the growth of cancer cells which are already present, not actually causing the cancer.

Many women and healthcare professionals have worried for years about HRT and breast risk and while it is important, it needs to be kept in perspective. Being overweight or drinking alcohol can be a bigger risk! Also, the breast risk from HRT which was highly publicised form the WHI trial published in 2002, was not in fact statistically significant.

Many women continue to have menopausal symptoms in their 60s, 70s, even some in 80s and so for them treatment continues to be required. The duration of symptoms cannot be predicted and so neither can the duration that HRT will be needed.

The longer that HRT is taken, the better it is for bone health and may have beneficial effect for osteoarthritis.

A risk that does increase with age is risk of deep vein thrombosis (DVT--blood clot in legs or lungs). Since there is a small risk of DVT with tablet estrogen, consideration should be given to taking estrogen through the skin (patch or gel) when continuing it over age 60 since this route does not increase the DVT risk.

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