Dear Dr Mitchell,
I'm going through menopause, and my doctor has recently prescribed hormone therapy to help with the symptoms. The problem is this: I read somewhere that taking hormones post-menopause can heighten one's risk for breast cancer, and earlier in life I've had several biopsies done to remove lumps (all of which turned out benign).

I told my doctor this and he said not to worry, to just do regular checks for lumps, but I'm thinking, if I can possibly stop myself from getting the disease, that's better than trying to detect it and curing it. Should I really take the hormones and not worry? What say you?

Hormone replacement therapy provides a woman, who is postmenopausal, with either a combination of oestrogen and progesterone or oestrogen alone. The menopause is the complete disappearance of a woman's monthly periods for a period of 12 months and this is due to declining production of oestrogen and progesterone by the ovaries.

There are established risks and benefits of taking Hormone Replacement Treatment (HRT). Studies done recently have shown that the risks outweigh the benefits. In a study called the Women's Health Initiative (WHI) it was found that the combined HRT drugs caused an increase in breast cancer, heart attacks, strokes and blood clots.

These risks far outweigh the drugs' actual benefit of a small decrease in hip fractures and a decrease in the number of colorectal cancers. The risk to the individual woman may be small but the number of cases occurring in the population at large can be great.

Women with a uterus currently taking oestrogen plus progestin should have a serious talk with their gynaecologist or family doctor to see if they should continue it. If they are taking hormone replacement for short-term relief of symptoms it may be considered reasonable to continue it if the benefits are significant.

Long-term use or the use for disease prevention should be re-evaluated considering the multiple adverse effects noted in the women's health initiative study.

The important thing is to identify women who are not candidates for HRT. This includes women with vaginal bleeding of an unknown cause, women with suspected breast cancer or history of breast cancer, chronic liver disease and a history of thromboembolism (blood clots).

The decision to use HRT needs to be made on an individual basis taking into consideration symptoms, personal health, family history risks and benefits of HRT. Alternative options for treatment and personal preferences should also be considered.

Women considering HRT need to be aware that the increased risk of breast cancer increases the longer it is taken, and starts to become apparent within 1-2 years of starting these hormones The risk of developing breast cancer begins to fall when the hormone is stopped and after 5 years it reaches the same level as for a woman who has never taken hormone replacement treatment.

The increase in risk when taking combined oestrogen and progesterone is substantially higher than that for oestrogen only hormone replacement therapy.

Alternative treatment options include:
. Discontinuation of smoking, weight, blood pressure and cholesterol control to reduce the risk of heart disease.
. The use of antidepressants to relieve hot flushes
. The use of regular weight-bearing exercise and bisphosphonate drugs such as Fosamax to help protect against osteoporosis.

Herbal remedies are not necessarily safe and there is limited data available on the adverse effects of these drugs. Some do have dangerous health risks and caution must be exercised. A popular herbal remedy used is Black Cohosh. Soy has also been widely used, but excessive consumption to relieve hot flushes may actually increase your caloric intake significantly. St John's Wort and Wild yam have also been used.

It is extremely important that you consult your gynaecologist and identify any adverse risk factors that you might have which would increase your risk for complications on HRT. Alternatives to HRT and discontinuation of the hormones should also be considered especially in view of your history of recurrent breast lumps.
Best wishes.

Dr Sharmaine Mitchell is an Obstetrician and Gynaecologist. Send questions or comments by e-mail to allwoman@jamaicaobserver.com, fax to 968-2025 or call 511-2502 to leave a 30-second voicemail message.

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