Breast Menopause

In premenopausal women the ovary is the richest source of aromatase and hence estrogen. Aromatase is confined to the granulosa cells and is produced under the influence of gonadotropins (FSH and LH). Despite being a rich source of aromatase, three separate studies have shown that aromatase inhibitors are unable to sufficiently suppress ovarian estrogen production to postmenopausal levels. One explanation for this phenomenon may be a compensatory rise in gonadotrophins which maintains adequate estrogen production, despite the presence of the inhibitor. As such aromatase inhibitors cannot be used in premenopausal breast cancer patients. After menopause, ovarian... 

M ale and female hormones play a vital role because they aid in development and maintenance of secondary sex characteristics and are necessary for human reproduction. Although hormones are naturally produced by die body, administration of a male or female hormone may be indicated in the treatment of certain disorders, such as inoperable breast cancer, male hypogonadism, and male or female hormone deficiency. Hormones also are used as contraceptives and for treating the symptoms of menopause... 

Breast cancer in menopausal women, preventative therapy for women at high risk for breast cancer... 

Breast cancer is one of the most common forms of cancer affecting women and, in Western countries, the incidence is rising. The risk of breast cancer increases markedly with age, although a decrease in the rate occurs after the menopause, suggesting that development is hormone-dependent. To date, a number of hormone-related risk factors have been identified (Bingham et al, 1998). Countries such as Japan have relatively low rates of breast cancer, which have been associated with consumption of a diet high in soy foods. Currently, however, the data from epidemiological studies is inconclusive. 

There is much interest in the possible hormonal effects of phytoestrogens in both men and women. The majority of studies conducted in women have examined the ability of phytoestrogens to alleviate menopausal symptoms. Whilst hormone replacement therapy is recommended for women experiencing menopausal symptoms, there remains some uncertainty as to whether HRT can increase the risk of breast cancer. As a result of these concerns, investigations into natural alternatives such as phytoestrogens have received considerable attention. 

CD Since the publication of the Women s Health Initiative study, there has been an increase in the use of non-hormonal therapies for the management of menopausal symptoms. Particularly for women with CHD and breast cancer risk factors, non-hormonal therapies may offer an alternative to assist with symptom management. A wide range of therapies, both prescription and herbal, have been studied with varying degrees of success. In choosing a particular therapy, it is important to match patient symptoms with a therapy that is not only effective but also safe. 

This series of trials, and many more, has led to the dramatic change in how HRT is currently prescribed and greater understanding of the associated risks. HRT, once thought of as a cure-all for menopausal symptoms, is now a therapy that should be used only to reduce the frequency and severity of vasomotor symptoms associated with menopause in women without risk factors for CHD or breast cancer. The changes that have occurred over the years in the use of HRT further support the importance of evidence-based practice and judicious medication use. 

HRT on the incidence of venous thromboembolism, breast cancer, or CHD. Lower-dose HRT provides women with an alternative to standard-dose HRT for menopausal symptoms but also should be recommended only for a short duration. Although many women have switched to lower-dose HRT,... 

HRT is indicated primarily for the relief of moderate to severe vasomotor symptoms. It remains the most effective treatment for vasomotor symptoms and should be considered only in women experiencing those symptoms. Women with mild vasomotor symptoms may benefit from nonpharmacologic therapy alone however, many women will seek medical treatment for these symptoms. The benefits of HRT outweigh the risks in women who do not have CHD or CHD and breast cancer risk factors however, careful consideration should be given to alternative therapies for the relief of menopausal symptoms in women with these risks. Women should be involved in the decision and may choose to use HRT despite having some risk factors owing to the severity of their symptoms. Regardless of the situation, HRT should be prescribed at the lowest dose that relieves or reduces menopausal symptoms and should be recommended only for short-term use. Women should be reassessed every 6 to 12 months, and discontinuation of therapy should be considered. 

A number of endocrine factors have been linked to the incidence of breast cancer.5,6 Many of these relate to the total duration of menstrual life. Early menarche (prior to age 12) and late menopause (after age 55) increase a women s breast cancer risk. Similarly, investigators have reported that bilateral oophorectomy prior to age 35 reduces the relative risk of developing breast cancer. Nulliparity and a late age at first birth (greater than or equal to 30 years) have been reported to increase the lifetime risk of developing breast cancer twofold. 

An NIH Consensus Development Conference Statement22 advises that adjuvant hormonal therapy should be recommended to women whose tumors contain hormone-receptor protein regardless of age, menopausal status, involvement of axillary lymph nodes, or tumor size. They also support a benefit of adjuvant chemotherapy for most women with lymph node metastases or with primary breast cancers larger than 1 cm in diameter (both node-negative and node-positive).22... 

Tamoxifen is discussed in Chap. 61, Breast Cancer raloxifene is discussed in Chap. 3, Osteoporosis. Raloxifene decreases bone loss in recently menopausal women without affecting the endometrium and has estrogen-like actions on lipid metabolism. It may exacerbate vasomotor symptoms, and it increases the risk of venous thromboembolism and stroke. 

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