Menopause represents a time of change and new opportunity for women – but the hot flushes, mood changes, and sleep disturbances can be frustrating in the short-term. The challenges are even greater now that fewer women are choosing to use hormone replacement therapy due to the health risks – most notably the increased risk of breast cancer. Despite this risk, some doctors are still recommending that women use hormone replacement therapy for short periods of time around the time of menopause to relieve hot flushes and mood disturbances. The rationale is that short-term use of hormones should have little effect on breast cancer risk. Unfortunately, a recent study shows this may not be the case.

A new study published in the Journal of Clinical Oncology shows that even short-term hormone replacement therapy for hot flushes started at the time of menopause increases the risk of breast cancer. In fact, the timing of when the hormones are given appears to affect the risk. The researchers looked at data on 53,310 women who had undergone menopause and followed them for eight years for evidence of breast cancer. In these women, they found that starting combined hormone replacement therapy for hot flushes right after menopause carried a greater risk than using hormone replacement therapy later on. The magic number seemed to be three. Women who used hormones within three years of menopause had a fifty-four percent increased risk, while women who used hormones on a short-term basis three or more years after going through menopause didn’t appear to have an increased risk.

In this study, it was also important how long the women used hormone replacement therapy. When combined hormone therapy was used for two years or longer, the risk of breast cancer was elevated no matter when it was started.

What do these findings suggest? Hormone replacement therapy for hot flushes and menopausal symptoms doesn’t appear to be safe even for short periods of time when started at the time of menopause which is when most women request therapy. Women are less likely to ask for hormone replacement therapy later on since they’ve adapted to some of the changes and the hot flushes may not be as pronounced – even though this is the time it would appear to be the safest.  
The bottom line?

Combined hormone replacement therapy for menopausal symptoms appears to increase the risk of breast cancer even when used short-term at the time of menopause. Although it may provide relief for the hot flushes and sleep problems, the risk may not be worth it, particularly if there’s a family history of breast cancer.