January 8, 2002
Hormone replacement therapy and cancer: Balancing safety and quality
of life
Promise for the future
As they try to guide their patients through the increasingly complex puzzle of HRT and cancer, Dana-Farber experts remind them that there are other ways to alleviate menopausal symptoms and that new drugs are on the horizon.
To minimize hot flashes, some women may be able to take certain forms of progestin or a blood pressure medication called clonidine. Drugs called selective serotonin re-uptake inhibitors (SSRIs) such as paroxetine (Paxil) or fluoxetine (Prozac), which are generally used to treat depression, can reduce hot flashes and relieve insomnia. Soy compounds have been shown to ease hot flashes in some studies. Calcium supplements and weight-bearing exercise can increase bone density. Vaginal estrogen therapy is a safe way to combat dryness, and nonhormonal, over-the-counter creams and lubricants can also help.
Selective estrogen-receptor modulators (SERMs), agents similar to tamoxifen, may one day become treatments for menopausal symptoms. These "designer estrogens" block estrogen in some tissues, but not others. For example, they may help treat or prevent breast cancer by blocking estrogen in the breast. Raloxifene, another SERM, is used to strengthen bones. Like estrogen, however, some of these drugs may raise the risk of endometrial cancer, and in research done to date, they do not relieve hot flashes in most women. Dana-Farber researchers are working to refine the activity of these drugs and to introduce new ones. Elsewhere, there are many new drugs in development. "The hope," says Dr. Garber, "is that one day scientists will modify these compounds to come up with the perfect SERM: one that does only good things."
(This story first appeared in the Winter/Spring 2003 edition of Turning Point.)
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