However we can only deduct a correlation as not all women who are taking HRT in their lifetime exposure to HRT will develop any breast tumour. When synthetic hormones are placed inside a body which is no longer producing them the effect is that the body will not benefit from it so well and as mentioned beforehand there will be a stimulus for cell proliferation (uncontrollable multiplication of cells which is not following the steps of normal cell division)
"Women on combined hormone therapy with oestrogen plus progesterone were twice as likely to die from breast cancer compared to women receiving placebo," says medical oncologist and study author Dr. Rowan Chlebowski.
HRT on CVD
It has been found that the women receiving HRT have a higher risk of heart attacks and cardiac events. A study taken by the European heart Journal has looked at 700,000 women who were aged in their 50-60s and were using HRT. They found that women at the lower end of the age group, between 51 and 54, were 24 per cent more likely to suffer a heart attack than women who never took the hormones. Taking HRT for more than four years could increase their risk by 59 per cent. The results of this study show that when the other factors which could have assisted have been ruled out the results could become more reliable. In general the cohort study included a large study size which shows that there is a good representation of the public. The methods used for the production of this data are very reliable as they were conducted by the European Journal of Cardiology, which in order to present its information firstly allows other scientists to read its results. If the results can be reproduced, it actively shows that the way they had conducted their study was logical and accurate. The results for this study were, reproduced and by many sources (e.g. in 5,6 and ). This study was one of the largest carried out since the WHI in 2002 – which was predominantly cancelled. The WHI study had caused many hazards which are why it had to be abandoned. With relation to this fact the study done by the European Heart Journal had not had any violations of such; this shows that effective study had been planned out.
HRT is also known to cause Clotting Problems – Venous thromboembolism (VTE) (this is when a blot clot forms in a vein). There has been evidence indicating that HRT can cause an increased risk of blood clot. Evidence taken from the WHI trial supported this, however the risk was shown to be very minor especially as only 1.7% of the 10,000 participants showed any signs of VTE. Women over 50 had the risk doubled. When other factors were included in the review it was proposed that the greatest risk applies to those who have a significant amount of risk factors.
Evidently to risk of heart disease, breast cancer and any other complications which may arise out of the risks HRT poses for women can be viewed subjectively. Whether the use of a drug may affect one woman in a certain way does not mean it will affect the next the same. The actual risk of using HRT is considered quite low, however the way this risk is perceived can affect the range of alternative treatments which are available to women. While many believe HRT should be stopped, there is also a vast majority who feel that HRT provides more benefits than risks, and that risks are too small anyway (e.g. video ). Who do we believe?
Raloxifene is a nonsteroidal compound, which is known not to increase the risk of endometrial cancer, and also may decrease the risk of breast cancer as data positively shows that the link between cancer and this drug is very little. Overall it can be said that Raloxifene has no associated problems which HRT does. Its role in reducing breast cancer cases can be viewed in Figure 1, where it can be seen a huge difference on its impact on breast cancer compared with HRT. Raloxifene alleviates hot flushes and night sweats as well as being good at maintaining strong bones and is prescribed to many to prevent osteoporosis. Raloxifene does have implications to its patients as well: Raloxifene is a substance which has many similarities to HRT because their chemical structures are alike. Due to this Raloxifene holds; a high risk of venous thromobolism and death from stroke.
Implications of treatment
An economic implication of the use of a medically prescribed drug such as Raloxifene can be very expensive to provide. On average this drug is more expensive than the existing therapies which are available. If women were to become dependant on this drug for a long time there would also be a lot of financial problems. The initial annual outlined cost of Raloxifene could be as much as £63,000 per 100,000 people. The problem here would be that while HRT stands to be hazardous, the NHS/government may believe that the benefits outweigh the treatments. Investing in a drug which could cost more but does the same job but with fewer hazards might be creating unwanted financial implications. This has already been addressed as an issue by the UK Medical Information centre.
The ethical implication is whether cutting down the amount of HRT dispersed to women is going to cause more problems for them than benefits. Women who are fully dependant on HRT may suffer greatly. The question is whether cutting down HRT to patients would be beneficial for all. HRT does carry a lot of unwanted hazards yet not everyone on HRT is prone to developing these hazards. We can look at this from a utilitarianist view where of course the advantages will be potentially higher than the negatives. However a proportion of women will be prone to suffering as they are fully dependant on the use of HRT. The problem here is that we shouldn’t just aim to maximise the good in one sector, if HRT was not diminished in the dependant groups then an ethical implication wouldn’t arise.
In mid-September, the U.S. Food and Drug Administration approved raloxifene (brand name Evista) as a breast cancer prevention treatment for postmenopausal women at high risk of getting the disease.
Alternative Treatments
Herbal Remedies
BIO-IDENTICALS Bio-identical hormones are naturally produced hormones which resemble our own hormones . They are in fact very similar to the hormones used in Hormone Replacement Therapy, which are also produced from natural sources, but, unlike HRT hormones, are given in unregulated amounts, with little evidence that they are safe.
Alternative medicines
Strontium Ranelate. This drug prevents the occurrence of osteoporosis. This drug binds tightly to the bone marrow and prevents calcium from being removed, also it stimulates the formation of new bone, and this keeps the bones strong and less likely to break
SSRIs and SNRIs
Selective serotonin reuptake inhibitors (SSRIs) are antidepressant drugs. A while ago it was noticed as a side-effect that menopausal women who took these drugs for depression had fewer hot flushes. Since then, research trials have confirmed that several SSRIs stop or reduce hot flushes in some (but not all) menopausal women. How SSRIs and SNRIs work to help hot flushes is not clear.
SSRI or SNRI gives relief from hot flushes nearly immediately. A 2 week trial is usually enough to find out whether it is going to work or not. If symptoms improve, a longer course may then be prescribed. The side effect which was mainly noticed was nausea.
Conclusion
HRT continues to be used by a quite large percentage of women. This is because many doctors still hold their view that it has less harmful effects on the body than benefits. This issue will continue to be faced because HRT to combat menopause has in reality become a bit of a convention. However we can address some of the positives to date; continuous studies are being conducted to test the hypothesis that HRT has a drastic effect on women’s bodies. As research becomes more advanced, HRT will eventually not be used as a drug for menopause. Safe drugs such as Raloxifene could potentially not only cut down cases of heart disease and cancer but actually used effectively as a treatment for the prevention of breast cancer. This suggests that putting more investment into this drug is an effective solution to the problem. The dispersion of Raloxifene along with evidence of its success (Figure 4) will reinstate that women are better of without HRT.
Figure 4
Continuous HRT (a continuous combination of oestrogen and progesterone) carried a 35% increased risk of heart attacks compared with women who had never used HRT.
Additional risk from HRT only applies if it is then taken for more than 5 years after 50.
Evaluation of sources
- Say no to cancer by Patrick Holford Chapter 8 page 51-65. First Published in 1999 by Judy Piaktus publishers Ltd. ISBN 0 7499 1953 1
This book is very good at describing the symptoms and effects of breast cancer itself. There is also some good primary citing of how HRT has an effect on hormones in women. This book is aimed at readers who have been diagnosed or know someone who is diagnosed with breast cancer. This leaves the facts quite simplified and therefore we may not be given the bigger picture. This source can be rated moderate and not the most informative, however we must credit the fact that it was written by a doctor who has had a lot of training in that field, indicating that the information is correct
- http://eurjhf.oxfordjournals.org/content/5/2/113.full (visited 04/03/2011)
The research from this article has been proven by the Journal of the American College of Cardiology which is a highly reliable source which conducts and produces a lot of self-conducted research which is globally applauded for its research into the different fields of cardiology. We can also conclude that the source is reliable due to its research being in agreement with other organisations. The source is reliable as the medical assertions made by it are made by professionals who have sufficient knowledge of the sector in order to make a valid statement; also the studies are conducted in order to reflect population as a whole. The article itself has been cited in other articles (e.g.). This means that they credit the information and consider it valid themselves.
http://ezinearticles.com/?Benefits-and-Hazards-of-Hormone-Replacement-Therapy-(HRT)&id=3939659
Say no to cancer by Patrick Holford Chapter 8 page 51-65. First Published in 1999 by Judy Piaktus publishers Ltd. ISBN 0 7499 1953 1
http://womenshealth.about.com/cs/hormonetherapy/a/hrtbrstcncrrisk.htm
http://www.bmj.com/content/341/bmj.c5307.full (visited 04/03/2011)
http://pagingdrgupta.blogs.cnn.com/2010/10/19/study-hrt-increases-breast-cancer-death-risk/ (visited 04/03/2011)
http://www.doctorsofusc.com/condition/document/31414 (visited 03/03/2011)
http://www.telegraph.co.uk/health/3108931/HRT-can-increase-some-womens-risk-of-heart-attack-by-a-quarter.html
http://eurjhf.oxfordjournals.org/content/5/2/113.full (visited 04/03/2011)
http://www.menopausematters.co.uk/risks.php
. An interview with Dr. William Creasman
http://www.natural-hormones.net/estrogen/research/new-therapies-used-estrogen-deficiency-postmenopausal-women.htm
http://www.ukmi.nhs.uk/NewMaterial/html/docs/raloxifene.pdf
http://www.dslrf.org/searchresults.asp?search=dcis
http://www.patient.co.uk/medicine/Strontium-ranelate.htm
http://www.patient.co.uk/health/Menopause-Alternatives-to-HRT.htm
http://www.rcog.org.uk/files/rcog-corp/SAC%20Paper%206%20Alternatives%20to%20HRT.pdf
http://www.pabreastcancer.org/template/userfiles/files/Newsletter/PinkLink/2006%2005%20May.pdf
European Society of Cardiology (2008, October 2). Hormone Replacement Therapy And Heart Attack Risk: Danish Study Provides New Information. ScienceDaily. Retrieved April 8, 2011, from http://www.sciencedaily.com /releases/2008/10/081001093504.htm
http://www.menopausematters.co.uk/risks.php
http://content.onlinejacc.org/cgi/content/long/38/1/1 (visited 04/03/2011)
http://eurjhf.oxfordjournals.org/content/5/2/113.full (visited 04/03/2011)