Menopausal Health After Breast Cancer

The gradual decline in estrogen production that follows menopause often contributes to significant climacteric symptoms, accelerated bone loss, and cardiovascular morbidity. Estrogen replacement can prevent or reverse many postmenopausal morbidities and has been widely used for several decades. The concern that researchers in early studies may have been hasty in their conclusions about the safety of estrogen replacement has prompted the reassessment of old data and further analyses of large groups of women. These new analyses take into consideration age, estrogen formulation, and duration of estrogen administration as risk factors for breast cancer. An emerging consensus is that very prolonged estrogen use may contribute to breast cancer risk. The suggestion that women who have previously undergone treatment for breast cancer should not receive exogenous estrogen has constituted one area of general agreement for many years. Accordingly, alternative strategies have been developed to address postmenopausal health needs for breast cancer survivors. However, this proscription has been challenged in recent years because both the population characteristics and health needs of women with a prior diagnosis of breast cancer have been changing. Recent information about the outcome of women who elect to take estrogen after breast cancer as well as those who develop breast cancer while taking estrogen is contributing to the emerging opinion that decisions regarding estrogen may be individualized in some cases.