Hormonal Therapy: Symptomatology versus Prevention

Many times, hormone therapy is used for symptom relief. In this case, hormone therapy is used to reduce hot flashes, vaginal dryness, insomnia and night sweats. These are the usual symptoms many women experience during their perimenopausal years. In natural menopause, these symptoms are usually transient, lasting about 3 to 5 years. After that, the body readjusts itself and you are fine. Short-term use of hormones, approximately 3 to 5 years for women who do not have breast cancer or blood clotting disorders is probably safe. At the end of the period, they should taper off the hormones over 6 to 9 months in order to ensure that the abrupt change doesn't bring back the symptoms. In women who have had breast cancer it is better to explore alternative methods to decrease perimenopausal symptoms.
In the case of disease prevention, hormones are taken with or without experiencing symptoms indefinitely. Seemingly this is done to prevent diseases of old age - heart disease and osteoporosis.
So what then is the importance of hormone therapy in relation to breast cancer? The first thing to consider is the quality of the evidence linking breast cancer with estrogen. From an epidemiological, biological standpoint, there is fairly good evidence. Women who have their ovaries removed at an early age rarely get breast cancer. It seems that the younger a woman was at her first period and the older she is at menopause; the more likely she is to get the disease. Simply put, the more years she is exposed to cycling estrogen, the higher her risk. These are biological implications.
Women who have osteoporosis have a 60% lower risk of getting breast cancer. If you have inherently low levels of estrogen, you tend to have bad bones and good breasts. On the other hand, if you have inherently high levels of estrogen, you tend to have good bones and bad breasts. Obesity in postmenopausal women, which is linked to higher levels of estrogen, creates a higher risk of breast cancer.
There is another reason that the connection between hormone therapy and breast cancer is biologically plausible. If you plot the rate of breast cancer with age, starting at age 20, a straight line will be obvious. The rate of breast cancer remains the same - until menopause. After menopause, the rate is less.
Conversely though, there is a reason why it is difficult to establish with certainty the connection between hormone therapy and breast cancer and that is that it may affect some women more than others. One of the things current research may help do is distinguish between the women for whom hormone therapy is dangerous and those for whom it's not.
There is a recent, rather frightening, study showing that women who take both birth control pills and hormone therapy have a higher risk of getting breast cancer. The baby boomers were the first group to do this; they were the young women on birth control pills and now are the middle-aged women taking hormones. According to this study's findings, short-term use of either one doesn't seem to make a difference. But women who were on oral contraceptives for more than 10 years and then took hormone therapy for 3 or more years, had a relative risk of 3:2 - more than triple the risk of women who never used either. Although this is quite a small study, with only 25 women participating, it is still something to keep in mind. It points out one of the ways in which baby boomers are different from past generations. If we base our estimates of risk on our mothers' experiences, it may not be realistic, because they were not taking these hormones throughout their lives.