HORMONE REPLACEMENT THERAPY: FACTS ABOUT OESTROGEN AND CANCER OF THE UTERUS (ENDOMETRIAL CANCER)
After middle life women, and men too, become anxious about cancer anywhere in their bodies, perhaps because old friends have died from it, and also perhaps because the menopause brings odd changes which make women preoccupied with their health. No one wants cancer, so it is no wonder that women and doctors too have reacted so strenuously to reports that oestrogen replacement may cause cancer of the uterus.
Before the menopause, oestrogen acts on the lining of the uterus (the endometrium), causing it to build up to form a bed for the fertilised egg. If fertilisation does not occur another hormone (progesterone) causes shedding of this lining and thus a monthly period is produced.
Later, if oestrogen is administered continuously without a break, or without added progestogen (which causes a shedding of the uterine lining) the endometrium builds up further and further and may give rise to endometrial hyperplasia. This in some women may go on to form cancer. However, if oestrogen is given with progestogen, shedding of the endometrium occurs regularly and it does not proceed on to hyperplasia.
Work has now been done which shows that if progestogen is given for 10-14 days each month with the oestrogen therapy then the incidence of hyperplasia and cancer of the lining of the uterus comes back to less than that in the normal community. That is if oestrogen is to be given safely then progestogen must be given with it.
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