Q&A: HRT & breast cancer risk; top reasons for fatigue; under-eye circles, & statins and muscle aches
Medical queries for the news-weary
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In this week’s reader-submitted Q&A, we’re tackling these questions:
How do I know whether I should take HRT?
Why am I so tired all the time?
How do I get rid of dark circles under my eyes?
Is my statin giving me muscle aches?
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Disclaimer: The views expressed here are entirely my own. They are not a substitute for advice from your personal physician.
The following subscriber questions have been lightly edited for length and clarity.
QUESTION #1: HRT & BREAST CANCER RISK
Hi! I’m 57 years old and I’m currently weighing the risks and benefits of HRT with my doctors. One of the biggest issues for me is that my mom was diagnosed with breast cancer at age 66 after taking the original HRT (in pill form). It’s particularly hard therefore for me to combat any fear or suspicion of HRT as a risk factor for breast cancer. Do you have any advice for how to approach the decision given that background? Thank you!
-Ann
Hi Ann,
I completely understand your concern, especially with your mother’s history of breast cancer. However, it’s important to understand that estrogen and progesterone themselves don’t cause breast cancer; rather, it is mutations in breast cells that cause breast cancer. The biggest risk factors for developing breast cancer are 1) female sex and 2) older age.
It is true that certain types of breast cancers can be stimulated by the presence of estrogen or progesterone (whether these hormones are produced by a woman’s ovaries or taken as hormone therapy), however a family history of breast cancer shouldn’t disqualify any woman from considering menopausal hormone replacement therapy (HRT).
One in eight women will develop breast cancer over time. Most breast cancers are not hereditary. Having someone in your family with cancer doesn’t necessarily mean that you have a genetic predisposition to breast cancer, though heredity can certainly be a factor. This is where you want to sit down with your doctor to discuss your individual risk.
Recall that for the majority of women, the benefits of hormone replacement therapy outweigh the risks if, that is, HRT is initiated within ten years of the woman’s last menstrual period. Of course the decision on when and if to start HRT is highly nuanced. I suggest checking out the latest expert opinion statement from the National American Menopause Society (NAMS), and perhaps bringing it with you to your appointment.
If systemic HRT isn’t right for you, recall that topical estrogen is exceedingly safe. It is dispensed as a tablet or cream, inserted intravaginally or applied externally, to help with vaginal dryness, pain, and sensitivity, and to help reduce the risk for urinary tract infections.
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QUESTION #2: TOP REASONS FOR FATIGUE
Why am I so tired all the time? I’m 51 and sleep okay. I take no medicines, just a daily vitamin. My doctor says I’m healthy (checkup in summer 2024). I can’t figure out why I‘m dragging at work and need to nap on weekends. Any ideas are appreciated!
- Alicia C
Dear Alicia,
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