The role of hormone replacement therapy in women with a previous diagnosisof breast cancer and a review of possible alternatives

Estrogen replacement therapy either with (HRT) or without (ERT) accompanyin g progesterone is routinely offered to well women at the time of menopause, in order to relieve vasomotor symptoms, (hot flashes), reduce urogenital a trophy and reduce the risks of cardiovascular disease, osteoporosis and per haps colon cancer and Alzheimer's disease. It is generally felt however, th at women with a previous diagnosis of breast cancer are not suitable candid ates for such therapy since either estrogen or progesterone may be associat ed with an increased risk of cancer recurrence. There are however, a variet y of approaches to menopausal therapy in such women. A careful history must first be taken in order to identify the symptoms or conditions of concern. Vasomotor symptoms can be reduced by the use of other medications such as the antidepressant venlafaxine (Effexor). Estring, a vaginal estrogen ring can be used to reduce genitourinary symptoms, with little systemic estrogen absorption. Osteoporosis can be prevented or treated with calcium suppleme nts, exercise, improved diet, bisphosphonates and/or selective estrogen rec eptor modulators (SERMs) while cardiovascular risk can be reduced by diet a nd exercise, as well as the appropriate use of lipid lowering and antihyper tensive medications.