Postmenopausal estrogens can reduce menopausal symptoms, risk of osteoporotic
fractures, and probably coronary heart disease. Adverse effects include venous
thrombosis and cancers of the endometrium and breast. The increased risk of
breast cancer is primarily among current or very recent estrogen users and
is directly related to duration of use.1
Addition of progestin to estrogen largely mitigates the increased risk
of endometrial cancer,2 and combination therapy
(opposed estrogen) has become the standard hormonal regimen for women with
a uterus. The impact of combined estrogen and progestin on risk of breast
cancer has been controversial. Although protective effects analogous to those
for endometrial cancer have been hypothesized for breast cancer, cyclical
use of progestin to simulate normal menstrual cycles increases mitotic activity
in the breast.3
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