CNN.com - Paging Dr. Gupta Blog

Maybe I am biased because I'm young, but after witnessing my mother go through menopause, I didn't see anything about it that couldn't be satisfactorily treated with a healthy diet and regular exercise. Hormone Replacement Therapy seems like such an incredibly risky gamble if you are faced with life that could lead to breast cancer, or life that leads to health and happiness. Am I totally off base on this?

I do not think that anyone who has not yet gone through the menopause should be making comments like "healthy diet and plenty of exercise" - absolute rubbish! I am 50 and a vegetarian with an extremely healthy diet and take more than the recommended daily exercise. However this has had no effect on the menopause symptoms. So after several months of hot flushes and problems in sleeping I went on to HRT. Within 5 days I felt like a new woman. It really is worth it. (my friends who have also had a difficult menopause feel the same way - they feel human again).

My question is if HRT causes breast cancer what about the pill in younger women. Can it really be safe to take the pill for years and years it it's unsafe to take HRT?

I have watched my aunt and stepmother go through menopause without HRT successfully. Yes, the hotflasshes and moodiness persist but these can be handled through diet, exercise, and vitamin supplements. One question, my GYN told me birth control equates to HRT as well, since it uses progesterone to "mimic" pregnancy. Are BCP hormones lumped in with HRT in the cancer risk?

This also supports the idea that women who take hormone shots for in vitro fertilization (IVF) are elevating their risks for breast cancer, as are women who have children when they are older, since that increases their lifetime exposure to estrogen. Doctors and the media should be more aggressive about letting these women know they are at higher risk, and therefore need to be sure to get mammograms every year...

I am confused - doesn't the contraceptive pill have estrogen in it? How come it is safe to take it in that form, but not around menopause in the form of HRT? If Breast cancer has been steadily on the rise since 1975, couldn't that show a link to the contraceptive pill - which, after all, really came into it's own in the late sixties, early seventies?

I am one of those women who has debilitating multiple hot flashes every hour as well as waking up all night long with night sweats. Not even daily exercise, diet, or alternative homeopathic remedies help. Therefore, even though I have a history of breast cancer in my family, I will continue to take the smallest dose of HRT which effectively lets me live my life without these debilitating symptoms. I am constantly talking to my doctors about the latest research for new remedies, but haven�t yet found one who can give me alternative answers. I will continue to do research on my own and will monitor my health with monthly self-breast examinations and yearly mammograms. Each woman has to make the best choice for her own situation.

I am a post menopausal 35 year old and I could not function without HRT. I can only hope to get through these symptoms quickly and get off HRT. Does it worry me? Heck yes. Can I deal with the hot flashes and constant weeping? Heck no.
I work out with a trainer 2x week, yoga 1x week and take deep water cardio classes 3x week. My diet consists of lean, hormone free protein, vegetables and 70oz of water per day. I am doing everything possible to control these symptoms. The only thing that works is the HRT.

This is wonderful news, but women need to have more facts regarding Biodentical hormones as well. Were they part of this testing?

I am currently experiencing menopause. I agree that proper diet and good exercise are key. Getting enough sleep is also important. I practice martial arts which engage the body, mind and spirit. Menopause is just another normal part of our lifecycle which we can accept and deal with. It's natural.

I have been on HRT since 2000 with the exception of the year after the report came out about the negative findings related to HRT. That year was unquestionably the worst for me and nothing, diet, exercise, vitamins, holistic, naturapathic, nothing abated the symptoms. Further, I could not tolerate any of the bone replacement therapies so I was at risk for osteoporosis. I went back on HRT and two years later, my bone scan looks good and I feel fantastic. I am willing to take the risk.

If estrogen contributes to breast cancer what about the contraceptive pills? I am quite possitive that it has the very same effect than HRT. It would be good to have more information on such an important issue.

I think it depends on the individual. It's great that some can go through menopause and not have to rely on hormones. But it's impossible for others. My mother always kept a healthy diet and exercise regimen, but she had a hysterectomy at 47 and needed the hormone therapy to simply feel at balance. I understand being cautious about hormones, but if you protect yourself to the point where you can't enjoy the life that you have now, then what's the point?

There is a huge difference between artificial hormones and natural hormone replacement therapy. All the testing that has been done was for Artificial hormones which can cause cancer. There is not enough data to help women make informed decisions. Having started pre-menopause at an early age--I doubt I could have servived the depression without HRT. There needs to be more information on natural hormones so women can make better life choices.

I have never taken a hormone in my life, have been thin all my life, and have done everything I could to avoid getting breast cancer. I was diagnosed with breast cancer last year at the age o 54-go figure!

I still think short term use of HRT is okay - it's long term use that really causes breast cancer. Any woman with menopause symptoms can use HRT for a year or so to get over the worst, but then its best to taper off. I know that the HRT drug companies put out lots of stuff - to doctors as well as patients - making it lok like you could stay young forever with HRT. WHI proved that wasn't true, and this sort of study proves that the risks of using HRT long term are just too great to simply manage hot flushes and crankiness.

I am a women in my fifties who has been taking a low-dose HRT for the past two years. I am one of those women who is afraid to stop taking it because I don't want menopausal symptoms to return and none of the natural remedies I tried prior to HRT work. Of course, I do not want to be a breast cancer statistic as you implied, but I don't want to suffer with hot flashes every day either. I often feel as though medicine and science tend to neglect the needs of female related diseases and problems until it reaches epidemic proportions or become newsworthy. Why can't something be done to ease the suffering we have to face daily because we are women?

I spent a year tapering off hormone replacement therapy and then quit. Within two weeks, the incredibly uncomfortable hot flashes returned. Today I take .3mg of estrogen every three days and it keeps the hot flashes at bay. My doctor said that small amount wouldn't help me, but it does. Hopefully it won't significantly increase my risk of breast cancer.

In 1992 I had breast cancer when I was 33 and have been clean since. When I reached menopause my doctor put me on Evista and 'knock on wood' I still haven't had a reocurrance. I believe the research because it has worked for me not to be on hormones. I will advise my daughter to do the same.

Doctors are telling patients the test results widely publshed about HRT are inconclusive.

I also took birth control pills for many years. I would like to hear Dr. Gupta's answer on questions that have previously been posted concerning these, and the comparison with HTRs.

I am a 41 year old breast cancer survivor who was on invitro fertilization just prior to my diagnosis. I was estrogen and progesterone positive. I had a lumpectomy with oopherectomy, chemo and radiation.I rapidly went into menopause after my oopherectomy. I have some advise for the ladies unsure of what to do with their menopause symptoms. If you think the menopause is bad, try chemo. Please, try and stick it out. There are many ways to try and feel better and for the most part, it is a temporary situation. If you do decide on HRT, do not forget your regular mammogram.

I have a horrible family history and right now I have a sister who is fighting for her life from breast cancer. I have tried to go off hormones, but I didn't even feel human. Headaches, lack of sleep and mood swings where taking a horrrible toll on me. I am taking my chances, since I have had a complete hysterectomy at a very young age for severe endrmetreosis. I am on the lowest dose of hormones and I am dilegently checking my breast and have a yearly mammogram. What is the right answer, I really don't know, but I do know that I want to be able to function.

Dr. Gupta,

I am reading with much interest in your blog of women complaining about the debilitating symptoms of menopause.
I keep on trying to tell my family and doctor how I feel-- grossly tired, run down, unable to wake up feeling good, etc.

They all either say " stop complaining and go to work" or ignore it. "Be a big girl, or stop sittin' around on your ass, mom" they say.

Seems to me some of us still live alone with this...

Patricia Dumas
The Jersey Shore

I've always maintained proper exercise and diet, have been very healthy, and thought others' stories about menopause were simply whining, and was certain I'd be immune to symptoms. I became menopausal at age 48 and attempted to tolerate the symptoms, but after months of sleepless nights and hot flashes I made the decision to accept the risks of HRT. I've been on bioidentical hormones for 18 months, with great improvement, but find I have to continually have them adjusted. I'm planning on obtaining a consultation for pellet implantation of estrogen, which supposedly provides improved regulation of hormone release and bypasses the liver. I have annual mammograms and female exams, but to me the risk is worth the improved quality of life, and my husband deserves it too. Unfortunately, the mainstream medical community is adverse to the treatment, which makes it even more difficult and costly for women like me who choose HRT.

I am a 17 year survivor of breast cancer, was diagnosed in my early 40's, was on taxifomen for 5 years which put me through the change at an early time in my life. Although I did have some problems related to early menopause I did not take any HRT, the risk wasn't worth it to me. In my opinion was better to deal with the promlems related to menopause than take a chance on reoccurence of my cancer.

Dr. Gupta my gynaecologist prescribed HRT for me. I took the hormones three times and suffered a heart attack. When I told my story to the doctors and nurses who treated me at the hospital, they all told me that it wasn't possible and that it was just a coincidence. However I was fortunate that my heart wasn't damaged but I am still taking medication to this day.

There is no one-size fits all solution as the severity of menopause symptoms vary significantly from one person to the next. I stopped HRT in 2002 but still experience about 10 hot flashes a day. Exercise and diet don't seem to have any effect on symptoms. If you are one of those with mild symptoms, count your blessings; but unless you've experienced the severe symptoms visited on some of us you have no idea how dibilitating the lack of sleep and hot flashes can be.

If there is a connection between HRT and breast cancer, isn't it probable that there is also one between birth control pills and breast cancer? How else do you explain the dramatic rise in breast cancer in baby boomer women who, not coincidentally, are the first generation to take the pill? I know that there has been research over the years that says there isn't a link, but I'm not so sure anymore. I took the pill for nine years in the late 70's and most of the 80's when it had higher hormone dosages, and sometimes I worry if it is a decision I will regret. The pill was supposed to liberate women, but that liberation may prove to have come at a very high price. I guess all I can do is get annual mammograms and hope for the best.

Intersting point made at the end of Dr. Gupta's blog in acknowledging that even in the face of evidence that the drop in HRT has correlated with an incredible drop in the number of women diagnosed with breast cancer, some women just will not listen out of the daily convenience to take the hormonal therapy to feel 100% better. Since doctors cannot say to a patient that had been on HRT that the treatment 'caused' the cancer, some women will still continue to put their lives at risk who later develop cancer that is fed on hormones. I am a graduate student working on breast cancer research and it certainly is the greatest joy in dedicating our lives to improving our knowledge of all aspects related to oncology in order to better diagnose and treat patients. Equally, if not most importantly perhaps, is fully understanding what causes the cancerous lessions (aside from the genetic ones that we cannot control) so that PREVENTION can be in practice. Preventing cancer onset by our lifestyle choices would have a global impact especially to the communities with a lack of medical assistance. Thanks for covering such an important issue.

I went through menopause at 38 so have been on HRT for 19 years. I have tried three times to get off HRT. This time I tried going "cold turkey" for a month. My bones ached, I have worse memory loss, I am sleep deprived and just generally feel unwell. So after a month of no HRT I went back on half strength to my normal dose and that ishelping. I am still getting hot flashes but not as bad. I am also taking Vitamin E and Evening Primrose but they say these remedies can take up to six months to kick in. I would like to get off HRT totally so I will do it gradually but one has to think of quality of life also. It is a huge thing when you are feeling lousy and amazing how HRT changes all that.

We insist on scientific evidence before we will support alternative treatments, and yet we immediately debunk HRT because some scientist postulate that maybe HRT was the culprit. Where is the scientific evidence that shows HRT is the cause of breast cancer? Please don't test one HRT and say "that's it." The scientific community needs to do more extensive research on HRT and the aging female.

Well, I'm 53 and just through menopause. I'm taking 200 mg of soy isoflavenes per day and that has eliminated my hot flashes. I don't know if it would work for everybody, but it's certainly helped me! My doctor is okay with it; she didn't want to give HRT and I haven't needed it.

I am 52 and still in peri-menopause. The single biggest help for me is accupunture and Chinese herbs. I also use western herbs sometimes, in a formula specifically for menopause. Additionally, fish oil caps make a difference. For sleep I take a Benadryl - chronic allergic rhinitis contributes to wakefulness from post-nasal drip, and my legs get jumpy at night. Benadryl eliminates both problems as well as causing drowsiness.

My mother describes a decade of hell preceeding and during menopause. Our lifestyles couldn't have been more different. But I work in a natural food store and have seen women with the same healthy habits as mine who have suffered miserably during menopause. It is too easy to pass judgement about lifestyle.

The problem was doctors pushing HRT on women who didn't need it and keeping them on it for years or decades, in the belief that it would improve their overall help, which had never been proved. The big study showed the opposite and should have come as a wake-up call to everyone who is taking drugs without long term study, on the basis of medical belief in their efficacy. (Statins come to mind.)

My mother-in-law had uterine cancer at age 87 - a real treat having a complete hysterectomy at that age - after over 40 years of HRT, which she took because the doctor said so (she is of the generation of people who rarely question doctors). No MD ever questioned the Rx until the day they diagnosed the cancer! Thanks alot.

We should only take drugs based on need and proof of long term safety. That would reduce many of the prescriptions being written nowadays and address some of our national health bill.

I am so happy to finally see this published. I am only waiting for younger women to find out that the birth control they are using is also increasing their risk. Next on the list would be our hormone filled dairy products and meat. I believe breast cancer is for the most part preventable, but we need to inform people.

Unlike many people, I do not think menopause is a "disease" that needs to be treated. I am 64 years old, and I refused to take hormones. I even switched doctors since my doctor was so gung-ho about getting me on horse-derived hormone pills. I am so grateful I declined.

I am 35 and had a total hysterectomy two years ago. Since then I have used the Ortho-Evra patch for HRT with very good results. Because of my particular case it has been recommended that I be on HRT for many years. I would like to know how cases like mine fall into these studies. There is never any mention of such cases and the effects of HRT on women with such long-term use. Any what are our alternatives?

My wife is at the tail end of Kemo and radiation treatment for breast cancer. She never took HRT. No one has been able to tell us why she got the cancer in the first place. Can you.

If estrogen-fed tumours are the problem, the contraceptive pill must be a factor in their growth. Since this is the case, women need to abandon the pill right away. Isn't that obvious?

I began the menopause process 12 years ago. I had all the classic symptoms and was, now and then, borderline miserable. I was wary of HRT, however, because of problems I'd had with the pill years before. My female doctor essentially "fired" me because I refused to use HRT and I was, in her opinion, too uncooperative. What helped me most was being informed. I studied and then found that exercise, vitamins and laying off the spicy foods relieved my symptoms considerably and just made me feel better, in general. I'm so glad I stayed my course and think everyone should basically do what she feels is best for her, despite the negatives.

I agree with Jennifer from Buffalo. I am a younger woman as well but I exercise, eat right and get enough sleep even though I have two small children. I have no PMS (which I think is a load of you know what), had very easy deliveries and stay away from trans fats and very processed foods. I am not a full time vegan or vegetarian but I believe there is a strong link to how we as a society feel when we eat pesticides, extremely processed foods etc. Do you know what Disodium Phosphate and Disodium Inosinate are? Well I don't either but if you eat Doritos they're in there and a lot of other foods. Go to Whole Foods and find healthier versions of the foods you love (including Doritos). Let me be clear, I'm not saying that everyone in the world is exaggerating about their symptoms but I really do believe that in this country we are so overmedicated and hypnotized by the drug companies that we don't try enough to feel better on our own.
Diane Schulz CPT

What age group was used in the WHI 2002 study? In the controlled group that used estrogen alone, the rate of increased breast cancer was actually insignificant. I think the media, again, is misinforming women about HRT.

Yea!!!! It is about time that we stumbled into some answers. There doesn't seem to be much progress in locating reasons for Breast Cancer. Makes me wonder if men had as much BC if there would be much more progress. Hmmmm

My mom, who's in her mid 70s, has always been strong, active and healthy; furthermore, she's always been one to "tough it out" rather than take medication. However, since she's had to stop HRT because of breast cancer risk, she says her quality of life has decreased so much that she'd much rather risk the cancer.

I haven't yet gone through it, so I don't know for sure. But like with everything else, a diet low in both sugar and fat (NOT just one or the other), and high in fiber, along with DAILY exercise and plenty of rest, has got to make a difference for most women. In addition, soy, which is a plant estrogen, may be a helpful thing to add to the daily diet. I have also read about the positive effects of Black Cohosh for women with hot flashes and other menopausal symptoms. The reality is, there is ALWAYS more than one solution to every problem, if there is any solution at all. Don't ever buy the bull that there is only one solution to a problem. The person who says this is simply too lazy to look for another solution. It is this very kind of thinking that got us into the current bloody war from which we now cannot find a graceful exit.

I also agree with posters who say there needs to be more pursuit of honesty in breast cancer research. It is illogical not to suspect that birth control pills, which have a MUCH HIGHER concentration of estrogen, are also contributing to skyrocketing breast cancer rates over the past 30 years. Once again, it seems that researchers have put their blinders on in the interest of being political correct.

Low levels of estrogen in post-menopausal women can lead to genital atrophy as well as lowering the risk of breast cancer. What kind of a choice is this?

I am 53 and finally post-menopausal. Every woman experiences menopause differently. Diet, exercise and supplements may be sufficient for some but for many they are not. I have almost every risk factor for osteoporosis and none for heart disease. I am seriously contemplating very low dose HRT because of its proven track record for increasing bone density (and don't tell me to use only diet, exericse and supplements to prevent osteoporosis--I already do that and it is not enough.) The link to breast cancer is very scary so I must weigh the "odds"--the possibly slight chance of getting breast cancer with HRT, or almost certainly suffering from osteoporosis without it.

When my menopause symptoms got to the point where I was having anxiety attacks with each hot flash and depression was creeping in, I went on HRT. Soon felt like my old self! Had great doctor's advice to wean myself off it after one year to see if it was still needed. I still have hot flashes at night, but totally do-able. The scarey news is that I just had an abnormal mammogram. I have to go for more films and a possible biopsy. I'm praying it's nothing...but if it is cancer...possible link to my HRT? I am considered post-menopausal now, and the rate of breast cancer at this point really goes up. In hindsight, I would have tried more natural remedies.

I'm 52, had a total hysterectomy 11 years ago and was on HRT until early this year when I developed a lump in one breast. It turned out to be pre-cancer, so am off the HRT and on Evista which has been found to aid in the prevention of breast cancer. I thought I would be unable to function without HRT, but experienced a brief period of mood swings, no hot flashes. I workout several times a week and try to eat healthy foods, and am fine now that my body has adjusted. I don't know what others have experienced, but for me, I want the lowest risk of cancer. I'll deal with the other problems.

I've been trying to avoid HRT for the last few months, and have found some relief with Remifemin (black cohosh),
and Chinese herbs. They're not an overnight fix, however, and took several weeks for symptoms to subside. If you can be patient, they're quite helpful (speaking from someone who could write a book about the misery of menopause!)It was a trial & error process, but I'm sleeping and feeling better.

I think it would be nice if instead of trying to recreate the wheel, research would be done on natural cures that may already be available. For example, there is a root in Mexico that helps regulate hormones. Could it be that it might not be as profitable as HRT?

Taking HRT to combat symptoms of menopause is a personal decision to be made by women along with advise from their physicians. Unfortunately, millions of women made the decision to take HRT without having accurate information about the risks and in fact they were told it was safe when it wasn't. A huge disservice has been done to women - widespread use of HRT was encouraged before the medical community really understood the risks. A 30% increase in any disease rate is outrageous.

It is interesting that when we see a dramatic increase in breast cancer (30% increase between 1975-2000) we also see a dramatic increase in abortions due to the leagalization of abortion in 1973. Many studies have proven the link between breast cancer and abortion (that the risk for breast cancer increases greatly when a woman has an abortion, and increases even more with each subsequent abortion). The increase is especially noteworthy in light the percentages of pregnancies ending in abortion (1/4--1/3 end that way). It would be worthwhile to compare current abortion trends with current breast cancer statistics.

I use Bio-Identical hormone repacement. It is a rice grain size implant enbedded into my hip every six months to a year. It is called SOTTO PELLE. Does this have the same effect on the heart as regular HRT?

I am 64 years old, took HRT for many years, and had breast cancer. For some of us, menopause is not "normal" and no amount of diet, exercise, herbs, etc., makes a dent in the debilitating hot flashes, night sweats, lack of sleep, and for some, mood swings. I tried to get off of HRT several times, managed to reduce the dose and only succeeded in quitting after I was diagnosed with breast cancer. I think it is realistic to take HRT at a lower dose and for a shorter time period, but the herbal remedies etc. don't come close to touching the problems that some of us have. Thankfully, 16 years after the start of menopause, I only have an occasional "warm" moment.

Why has the medical community failed to come up with a test that women can use for daily monitoring of hormone levels and adjust HRT dosage accordingly. Why is mandatory genetic testing not done on every women to determine if she has genetic markers for estrogen fueled breast cancer prior to any HRT prescription? Why are we not looking at other factors in the environment that may cause breast cancer? Finally, the "one size fit all" mentality should end. I believe there are women who will never need HRT replacement and women who will need it for perhaps a lifetime after menopause to function well. With better measures of hormone levels, testing of genetic markers and then, appropriate, customized dosage, women will be better served by the medical community!

Ever hear of bioidentical hormone replacement therapy?

Doctors should tell their patients that moodiness and hot flashes, no matter how extreme, are nothing compared to the side effects of chemotherapy and radiation. In addition, they do not kill you. No one knows all of the circumstances that can cause breast cancer, but the increased risk involving HRT is known. I watched my mother battle breast cancer for 15 years before she lost her life at 56 years old. I would do anything to reduce the risk of developing this deadly and painful disease, not only for myself but for my daughter.

I take estrogen..
I will continue to take it.. Even with this new "encouraging" study, I still think the risks of not having estrogen for our bodies outweigh the cancer risk..
We live longer and what is the use of living longer if we feel lousy? Are breaking bones, or we are stooped over and in pain? Have heart and health problems that prevent us from enjoying life.?
Mental confusion and frustration.
The only help for these health problems are other medications..
What are the health risks from them?
Some women do well after menapause there is no dought, many others do not..
What about birth control pills, estrogens and chemicals in food? I agree..How come we never hear about the effects of those on breast health..Or the risks for cancer later..
Are they effecting the study?
The study is just another of many and how many times have we been told somthing was bad and it turned out that it was Not...
On the other hand I do know how I feel without estrogen, I do know about the health risks of not having it too..
All these studies do is confuse and upset women..
It seems there is no perfect solution..Yet!
Or answers...

For the people--women included who believe that pre-menopausal women take HRT because we want to "feel better" do not have a working knowledge of what happens to a woman's body. It's not simply wanting to feel better--it's a matter of being able to function in our daily lives. Without HRT my mood swings were so awful I wanted to die. So if I have a choice between MAYBE getting breast cancer or living a normal live---I'll take my chances with HRT.

I too am one of those women whose menopause delilitates me totaly. I am a personal trainer and get plenty of exercise and have a very well developed diet. This makes no changes in the hormonally based effects that some women suffer from. Myself included. I do however beleive that dosages prior to these studies may have been too high. I take a miniscule amount and find that I am now able to handle the effects, both mentally and physically that menopause has blasted me with. Moodyness isnt the only mental symptom that comes with menopause, there is the anger, the depression, and sometimes the inability to control your thoughts and reactions. I know I experience all of them and have NO backround of mental instability in either myself or my family. So unless you have experienced what other women have experienced you can not say that all symptoms are handled by exercise and diet.

Three years ago I had a radical hysterectomy and immediately went into surgical menopause. I too had followed a proper diet, exercise and high quality vitamins and still developed cervical cancer within 6 months of my divorce.(stress yeah, I know, and HPV) If you think regular menopause is rough, try all the symptoms upon you at once. I literally went nuts and was ready to commit myself to a 30 day 24/7 mental facility, when I discovered I had the top ten symptoms of an estrogen deficiency. My doctor took me off the NHRT I had been on, gave me a shot of testosterone and immediately started me on 1 mg of an estrogen patch. Within 3-4 days I could tell the difference and within 7-10 days I was back. It was still a long, hard recovery but the HRT saved my life. I am not real keen on taking HRT but right now, until they come up with a better alternative, I can't live without it.

I was diagnosed with stage I breast cancer at age 40--no family history or other risk factors. I feel strongly that birth control pills are a risk factor because many women in their 30's and 40's are developing breast cancer, most of whom took birth control bills.

Hmm. Being given shots once a month plus being on Tamoxifen daily has put me into menopause. Night sweats and hot flashes -so what, I'd rather not get breast cancer again. Atrophic vaginitis - so what, I use Replens and Astroglide. Crankiness - no way, seems without all that estrogen I'm calmer and clear-headed.

For the cause to preceed the effect cancer initiation, growth & diagnosis would have to occur in one year or less? (July 2002 to decline noted in 2003)Isn't that counter to most thinking on tumor development?
Could the effect simply be on tumor growth? This would lead one to the depressing thought that there are just as many cancers out there, they just haven't grown large enough to be detected.

I was on HRT for more than ten years after my uterus and one ovary was removed. I stopped taking HRT once i changed my diet to vegetarian and have never looked back and that was six years ago. I am now 57 and still feel a flash every now and then but I have no regrets. My general health has improved since changing my diet.

I agree with an above comment that menopause is natural, and I would point out that for thousands of years women delt with it without HRT. I am young, so maybe I shouldn't speak on a subject I have not personally experienced, but I have watched all of the women in my family; grandmothers, mother, aunts, go through it without HRT. None of them believed it was a healthy thing to do - even before all of the research proving it. It may not have always been pleasant, but they did it. We need to stop relying on drugs to fix all of our problems, and I'm not just talking about HRT. Modern medicine is great, but just know that there is never a "magic pill" that has no consequences.

Have read with interest all the comments and would like to comment on the response from posted by San Antonia, TX at 12:48 pm ET. I too had severe endrometreosis at a young age and had a total hysterectomy in my early 40's. As I immediately went into surgical menopause I was put on HRT. I too chose to continue taking a low dose as the hot flashes were unbearable and as many, decided to take my chances. Imagine my surprise when I was diagnosed with Ovarian Cancer a year ago. Apparently some Ovarian tissue was left behind from the endometreosis surgery. It appears no one is "safe".

I'm a two-time breast cancer survivor at age 44. I've had a mastectomy and reconstruction, chemo (twice) and radiation. Give up your HRT!!! It's not worth it.

What about HRT creams?? Nothing is ever mentioned about it?

As a woman who is in the middle of menopause, without HRT, it can be done! Herbs have helped the hot flashes - not completely, but they are managable, and walking more has helped me sleep. The pill is as unsafe as HRT as it contains not only estrogen, but DES or diethylstilbestrol which is another huge problem.

As a Family Nurse Practitioner and as a surgical menopausal woman who is on HRT I can tell you that many woman continue to suffer dramatically from the decision to not take HRT. Unfortunately since the OB-GYN field is still pervasively a male dominated physican speciality that doesn't give a crap about menopause or it's symptoms, there is little hope on the future horizon for options to relieve said symptoms. If Menopausal symtpoms and the present HRT recommendations involved men, the penis and erections cutting research would be taking place 24/7 to develope a satisfactory solution.

I see many many comments here like "If HRT isn't safe, then why is birth control safe?" Well... IT IS NOT SAFE! "Combined oral contraceptives are carcinogenic to humans" according to the IARC. Please, if you use any type of hormonal contraceptive, do some research. I recommend reading this Wikipedia article. It has some great information and links to further sources.

I don't think you can generalize about whether menopause is easy to manage or not. Each person is different and one size does not fit all. For some, it is debilitating. Also, when a woman has to work the mood swings can be particularly difficult. I have seen some women almost lose jobs because of severe symptoms without HRT. For those women with or without severe symptoms who do not have the pressure of working, the process can be much easier. I have strong objections to physicians who give a blanket no to women who are requesting HRT without exploring their symptoms and lifestyle issues.

Every woman who goes through menopause has different symptoms. At 48 years old I had suicidal thoughts, depression, debilitating headaches, hot flashes, memory loss, hot sweats at night, extreme tiredness, and very little sleep. I tried diet and exercise but HRT was the answer for me and later I found human estradiol or 17-beta estradiol which targeted all the symptoms. No progestrin. My gyn doctor wants me off it and I've tried to but the symptoms come back and I need to work for a living. No one wants to work with a raving mad woman! I still continue to diet and exercise and look forward to the day I don't have to wear an estradiol patch. I'm glad the breast cancer rates are down. There is a small history in my family but it usually hits in our late 80's. So I know the risk I'm taking but I also want a life! Thanks for letting me express my opinion on this subject.

Now, should women fear that birth control pills can effect their likelihood of getting breast cancer? There are studies that show both ways...what do we trust?!

Ladies Choose Life!! At 38 yrs old I was diagnosed with breast cancer, hormone positive, and treatment took be into menopause. Now I am an eight year breast cancer survivor. Menopause symptoms, and I have them all, are nothing compared to chemo, surgery, radiation etc.... Believe me!!!!

I began taking HRT in 2001 to curtail for symptoms of menopause. Never missing a yearly exam or mammogram my OBGYN found a lump in my breast in 2003 and immediately took me off HRT.
One lumpectomy, Brachey therapy and eight brutal chemo treatments I am now 3.5 years clean. I am convinced that the HRT was a huge factor in getting breast cancer. I hated the hot flashes the weight gain and the sleepless nights...but not any more...I'm 59 and going stronger than ever! It wasn't a pretty sight with sweat pouring down my bald head but hey.. I'm OK now..
God Bless all of the breast cancer survivors and never, ever give up hope.

My mother was a control group participant of the Women's Health Initiative (WHI). She had a hysterectomy when she was in her 40's and has taken estrogen ever since. She is now 81 years old. She has never had breast cancer. The bone density test she had done earlier this year showed that she was in the best category possible for someone her age.

Although there was much publicity about the WHI study and the increased risk of heart disease and cancer among participants, later on there was very little publicity about how flawed the study was. (Postmenopausal women placed on higher dosages of HRT who had not taken it previously.)

Based on this and my symptoms that could not be controlled by many of the alternative therapies listed in postings above, I started the lowest HRT dosage about 6 months ago and could not be happier. I'll take my chances. My quality of life now is worth the risk in relation to breast cancer for which I am probably at low risk of developing.

A 14% drop in the diagnosis of breast cancer is significant. However, what caused the cancer in the remaining thousands of cases? Are certain people more at risk than others? What other factors play a part in anyone developing cancer? Is it the polluted air we breath, the water we drink or the food we eat? What impact does our genetic background have on this and other health issues?

I cannot see myself discontinuing HRT due to this latest statistic. I think that there are too many other unknown factors contributing to breast cancer.

Some people have asked about the pill and other birth control hormones and their affect on breast cancer, yet do we not recall that there has been publication that being on the pill reduces the chance of getting ovarian cancer?!?!?

As my mother had ovarian cancer, but was fortunate enough that the cancer was in a water-filled cyst that kept the cells from spreading, and the MUCH higher rate of death with ovarian cancer, I would wait until more conclusive testing came out. AND...by the way, yes go get the CA125 test but realize that it's not a 100% proof test. It would not have caught my mother's cancer.

What is important is to be your own best advocate. We can catch breast cancer much faster than we currently detect ovarian cancer. Know what runs in your family and what risk factors you have.

My belief is that the medical research is still to inconclusive to jump on or off medications.

Is there not also a correlation in women becoming more educated about their health, more assertive about doing their own research, and choosing healthier lifestyles? I don't think we can point to HRT as the culprit.

Just look at research we've seen in recent years: eat eggs, don't eat eggs. Drink red wine, don't drink alcohol. Eat chocolate, don't eat sugar.

In response to Fernando Hernandez question if anyone can tell him why his wife got breast cancer even though she never took HRT in her life: The studies correlating lifestyle choices to cancer are just that - a correlation. It can be a stronger one or a weaker one but it is never possible to "prove" either way since there are way too many factors that go into a person's life history that could have added to the likelihood of getting cancer. Please do not dismiss important scientific correlations that can help save many more lives by having women consider twice before going on HRT. Cancer can be caused by a whole number of factors, many of them that start out being genetic that we are not aware of carrying such mutations that can sporadically give onset to a certain cancer. Cancer is not one disease but a complex of many different aspects of the cells going array...hence, the difficulties even today to identify the reasons for each different cancer. We have to be patient and we have to help in the awareness for more scientific research. We have to also try to be positive in the face of hardship such as the case of your wife. I am sorry about her getting cancer but it is not a reason to become bitter towards possible breakthroughs in the understanding of the causes of cancer.

I work for a holistic women's health Clinic in Maine. If you can get your body to make your own hormones again, that's the absolute BEST thing you can do. And you can...with proper nutrition, exercise,stress reduction techniques and supplements, most women can start making their own hormones again. The symptoms you're experiencing will subside...they key is to get your body to start making its own hormones again--and it can be done.

Every woman's menopause is different. Mine is quite severe, and diet and exercise does not help. Not sleeping, severe night sweats and hot flashes, not thinking clearly have only been lessened thru HRT. I keep regular check ups with my doctor, I will stop when I feel I can function without it.

I am wondering, is this including all brands of HRT therapy, or just certain ones, and the dosage amount. The report seemed to be vague in this area.

My wife is a two time survivor of breast cancer and she too was concerned with HRT. After long debate and her struggles with menopause, she decided to go on a low dose HRT. It came down to quality of life. She has suffered so much with the chemo and now menopause, she has not felt well in years. That is until HRT. She now feels like "a new woman" and says that she would rather have 10 good years than 25 bad.

I was under the impression from my doctor that risks were largely associated with hormones that contained both estrogen and progesteron. Since I had a hysterectomy at age 49, I have been taking a low dose of estrogen only. Here is my dilemma. When I go off the estrogen my symptoms return. I can manage many of them, but the one that gets me the most is memory loss. And, sometimes I find I can't even put together a sentence.

At 39, I was diagnosed with stage 2 breast cancer. Prior to having my mastecomy, I had been on the birth control pill for many years. I often wonder about the risk I put myself in taking the pill every day. While undergoing chemotherapy, I saw an acupuncturist, who told me that the pill is not a biodegradable product, meaning it doesn't get flushed out of your body but rather stores it. I advise anyone I know of to get off the pill and find alternative methods of birth control. Going through breast cancer and the associated surgeries/treatments is very challenging when you are a mother to young children (my twin boys were 5 at the time). My hope is that we can raise the awareness of the risks associated by taking the pill and reduce the numbers of young women getting breast cancer, the same as we have done for post-menopausal women and HRT.

Sadly, what has NOT been commented on is what is the DEATH rate doing! The fact is, we already know that HRT can UNMASK tumors that are already there, but those patients on HRT have a BETTER SURVIVAL rate than those not on HRT.

So although identification of new breast cancers dropped (and the effect of a change in HRT usage is unknown), do those patients getting breast cancer survive it any better?

I ask my patients whether they want to IDENTIFY and TREAT a breast cancer or die of it...the answer, at least to me, seems obvious...

Nobody wants cancer - that's a no-brainer. But to say that HRT causes breast cancer is unfair. That it may unmask a tumor that is already there may be more accurate.

Unfortunately, the media fear storm has effectively taken the HRT option away from many women suffering with menopausal symptoms.

I am NOT an HRT salesman...I personally counsel my patients about many options, many of which are NOT HRT. But, I also try to give them objective data, and not just media fear...

My two cents...off my soapbox...

It's unbelievable how narrow minded people can be. Birth control pills may increase the risk of breast cancer but they also prevent unwanted pregnancy, lowers risk of ovarian cancer, likely lowers the risk of colon cancer, significantly helps women with painful or heavy periods, the list goes on. So, yes there is an increased risk but the ABSOLUTE risk is low (a chance of 2/5000 is twice the risk of 1/5000 but the absolute risk in both of these examples is still quite minute). There is a risk of dying when you drive to the grocery store. A risk of liver failure from taking too much Tylenol, a risk of kidney failure from takting too much Advil, etc.... The absolute risks from these examples are low as is the risk of breast cancer from taking HRT. Women need to know that if they take hormone replacement therapy there risk of breast cancer doesn't immediately go to 100%. They should also know that they have a risk of breast cancer even if they don't take HRT (in the women's health initiative the placebo group that took no HRT had annual rates of invasive breast cancer of 0.28%). It boils down to deciding if you want to have to deal with hot flashes, vaginal dryness, or mood swings or accept the real but small risk of an increased risk of breast cancer. It's not as cut and dried as people are making it.....and just because Jane chooses soy, etc doesn't mean that her friend is wrong to choose HRT. It is a PERSONAL decision not a one size fits all. There is way more to the issue than a blog can cover and Dr. Gupta should know better than to present a mere 365 days worth of data..........

I am 29 years old and going through menopause because of radiation for vaginal cancer. Menopause hit me like a brick. I was miserable, could not sleep, could not function..I felt like my life was ending. I have to take HRT because I was abruptly thrown into menopause. I do plan on tapering off in a couple of years, but right now, I need it to function. For me right now, taking them is worth the risk. I remember how I felt when I wasn't. It's a difficult situation, and taking the risk could very well mean that you take "Quality of Life" over "Quantity of Life."

Considering that the Janapese don't even have a word for menopause in their vocabulary, maybe we should study what they do and apply it along with a healthy lifestyle, wieght loss if applicable and lose bras which prevent the lymph from draining out of the breasts and increase the temperature of the breasts. Maybe also eat more natural foods and natural soy products to relieve the menopausal symptoms. Several women in my family have breezed through menopause with no symptoms at all.

This is an interesting topic for me, as a post-op transsexual woman. I have been on HRT now for over six years. I do regular breast self-exams, mammograms, etc. but no medical professionals seem to have much data for people with my condition. I know many hundreds of trans-women in the community and none of them have reported having breast cancer. This is still a strong concern of mine, considering we (trans-women) generally take higher doses of estrogen prior to surgery, than post-menopausal women do.

People have asked about birth control also being a concern. I think it is. My aunt and my best friends mom were recently diagnosed with breast cancer. Both doctors have come to the conclusion that is was most likely because of taking birth control and having HRT. Being on the birth control did increase their chances, but I don't know by how much. Menopause is going to be different for everyone, and everyone needs to decide if HRT is worth the risk for their personal situation. Personally, I would look at it as if there was a 100% chance of me getting breast cancer, would I still do the HRT... but that's just me.

My sister died of Breast Cancer.

She took the first birth control pills offered in the 1960's.

There was a very interesting documentary on PBS called "The Pill" on the history of the birth control pill.

It seems that these very early pills had very high hormone levels - and many women back then (in the 1960's) came down breast cancer then.

Since then, the level of hormones in birth control pills has been lowered considerably.

I think breast cancer rates will continue to decline, because all the women who took those early, high-dosage birth control pills in the 1960's have either already died, or already been cured. Young women who took the "pill" in the 1970's and beyond are less affected.

It disturbs me that no one seems to have made this basic connection - although the connection based on hormone replacement therapy would seem to point to it.

I'm not a scientist, but I'm just curious about whether the study they conducted found a strong correlation between the reduction in HRT and breast cancer rates and whether the link was statistically significant and how many potentially confounding variables they controlled for. We can't just assume causality between the two rates. It may be that the reduction in HRT use corresponded with an increased use of some sort of alternative medicine and THAT's what's actually impacting the breast cancer rate reduction.

Anyway,it wasn't clear to me in reading Dr. Sanjay's post that the correlation between the two had been found to be significant.

Perhaps that should be cleared up so people understand the limitations of the study. I know that the full story does qualify what is being said, but it doesn't appear to be qualified in the blog.

It's not that I'm into HRT treatments or anything. I'm not even perimenopausal and don't plan on taking hormones when that happens.

It's just that there's enough sweeping statements about research in the news nowadays and it's important to me to make sure what's reported is accurate so that all of a sudden people stop thinking that breast cancer's an important issue.

My mom had breast cancer before menopause, so the link to reducing HRT does apply in all cases.

Everyone who's mentioned birth control pills should note that women who take birth control pills are still producing estrogen, while post-menopausal women are not. Birth control does not increase the amount of estrogen and, in fact, may reduce it in some women, because it provides a steady dose of hormones. Studies have shown no link between pre-menopausal use of oral contraceptives and an increased risk of breast cancer.

As my mother has taken HRT, and I have taken birth control pills and currently use a low-dosage hormone IUD, I have been following this story and these comments with interest. It would seem that in some cases, a hormone-free course of treatment would work quite well, but it's also obvious that women experience a wide variety of symptoms and what is good for one patient is not necessarily good for all. Hopefully the medical community will approach this matter constructively and respectfully, without judgment.

Also, it is absurd to link abortion to breast cancer. No statistics support any relationship between this medical procedure and the onset of cancer. The commenter is either incredibly naive or is using fear tactics to push an agenda. Regardless, it was irresponsible to publish that comment.