STOP enforcing a 5-year rule for menopausal hormone therapy

Health-care practitioners also can minimize the risks of HT by monitoring outcomes, such as blood pressure, unscheduled bleeding, and so on.¹⁵ It also may be helpful to counsel patients about interventions for other conditions that contribute to risk, including obesity, smoking, inactivity, hypertension, and hyperlipidemia.

Quality of life was largely ignored in the decade after publication of the initial WHI findings because it was thought that the lives saved by avoiding HT would justify some level of distress.^6,7 There also was a presumption—promoted by advocates of natural products and alternative therapies—that interventions such as acupuncture, paced respiration, and herbal remedies were safe and effective at alleviating hot flashes, night sweats, mood swings, and sleep disruption. Complaints of vaginal dryness and dyspareunia from urogenital atrophy often were inadequately addressed because local estrogen was incorrectly thought to increase the risk of hormone-induced breast cancer. Rates of osteoporosis and hip fracture also have risen over the past decade as the protective effect of systemic HT for many women was lost.¹⁶

Although most postmenopausal women (60%) experience hot flashes for less than 7 years, as many as 15% report that hot flashes persist for 15 years or longer. The symptoms that can accompany hot flashes (including sweating, palpitations, apprehension, and anxiety) contribute to a woman’s discomfort, inconvenience, and distress, particularly when the hot flashes are frequent, and can be a significant contributor to sleep disturbance. Vasomotor symptoms adversely affect quality of life for 20% to 25% of women, primarily due to the physical discomfort and social embarrassment that they evoke—although night sweats and sleep disturbance also are reported to exert a negative impact.^17–19

THE BOTTOM LINE
Nothing magical happens after 5 years of HT to increase a woman’s risk of breast cancer. Any cumulative effect of combination HT on the risk of breast cancer is gradual and small. It is not appropriate to demand that a patient stop HT after 5 years if it affords dramatic improvement in her quality of life, provided she has been correctly informed about potential risks and chooses to continue with therapy.