Estrogen-Progestin HRT and Ovarian Cancer Risk
Estrogen-progestin tablets do not appear to reduce the risk of ovarian cancer and may even increase it, according to the federally funded Women’s Health Initiative Randomized Trial. The study was stopped in 2002 because of evidence that the combination hormone replacement therapy (HRT) raised the risk of breast cancer, heart attacks, and strokes.
Researchers set out to determine the possible associations of estrogen plus progestin on gynecological cancers and related diagnostic procedures. The effects of continuous combined hormone therapy on gynecological cancers had not been investigated previously in a randomized trial setting.
A double-blind, placebo-controlled trial enrolled 16,608 postmenopausal women who had not had a hysterectomy at the baseline evaluation and who had been recruited from 40 clinical centers in the U.S. between 1993 and 1998. cymbalta canada
The women received one tablet per day containing 0.625 mg of conjugated equine estrogens plus 2.5 mg of medroxyprogesterone acetate (n = 8,506) or placebo (n = 8,102).
The main outcome was invasive cancer of the ovary and endometrium. After 5.6 years of follow-up, there were 32 cases of invasive ovarian cancer, 58 cases of endometrial cancer, 1 case of non-endometrial uterine cancer, 13 cases of cervical cancer, and 7 cases of other gynecological cancers. The incidence of other gynecological cancers was low and did not differ according to the drug to which they had been assigned. More women taking estrogen plus progestin required endometrial biopsies.
The authors urged caution in prescribing the use of continuous combined hormones and mentioned that the increased burden of endometrial biopsies necessary to assess vaginal bleeding further limited the acceptability of the combination regimen.
The Women’s Health Initiative has also linked HRT with a possible risk of dementia. Women who take HRT for menopausal symptoms are advised to take the lowest possible dose for the shortest period of time.
An earlier study of menopausal women, who were observed from 1982 to 1996, repor ted that women who used supplemental estrogen for 10 years or more doubled their risk of dying from ovarian cancer, compared with nonusers. The risk persisted up to 29 years after the discontinuation of HRT. The actual risk of death from ovarian cancer was small (1%), although it increased to 2% in longterm estrogen users, according to the American Cancer Society. At that time, the possibly protective role of progesterone had not been examined.
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It is known that taking estrogen alone increases the risk of endometrial cancer in women who still have a uterus. The combined regimen of estrogen and progesterone is thought to protect against endometrial cancer. More studies are needed to examine the possible link between ovarian cancer and HRT.
