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Menopausal hormone therapy: a new risk?

Many women turn to hormone therapy during menopause to avoid night sweats, hot flushes and more dangerous problems, such as bone loss or heart disease. A new study now suggests one form of this therapy may cause an unexpected thickening of the endometrium, the lining of the uterus. If confirmed, the finding might reignite an endometrial-cancer scare that first erupted during the mid-1970s.

During the early days of hormone therapy, women received estrogen alone to block the undesired changes characteristic of menopause. When physicians started seeing an elevated endometrial-cancer risk among these women, scientists blamed estrogen, pointing to its ability to spur endometrial growth. Today physicians prescribe both estrogen and the hormone progesterone, which counters estrogen's endometrial growth message.

But once-a-day pills of both estrogen and progesterone may cause the endometrium to thicken, according to Kenneth A. Morhain, an obstetrician at Wright State University School of Medicine in Dayton, Ohio, and his colleagues. Though menstruating women develop a similar thickening, which sloughs off monthly, such an endometrial-cell buildup does not normally occur after menopause. However, the significance of this buildup "is really unknown," Morhain told SCIENCE NEWS.

His team studied the medical charts of 452 women treated daily for at least three months with progesterone and estrogen. The researchers focused on 32 women who experienced abnormal bleeding during therapy. Biopsies of their endometrial tissue showed an unexpected proliferation of cells in 22 women, or 69 percent. Morhain says the finding challenges earlier research indicating endometrial cells remain quiescent in postmenopausal women receiving continuous estrogen and progesterone therapy.

"It's an interesting finding," says Thomas E. Nolan of the Medical College of Georgia in Augusta. However, he warns that Morhain's team has not linked the thickening to cancer. Morhain agrees, but says that until further research proves the proliferation harmless, he may rely on a different regimen, one that more closely mirrors the natural cycle.
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Title Annotation:endometrial cancer
Author:Fackelmann, Kathy A.
Publication:Science News
Date:May 18, 1991
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