the main concern with prolonged ht is an increased risk of breast cancer. the risk seems to be greater in women taking combined therapy (estrogen plus a progestogen) than in women taking estrogen alone. and it may be that starting ht right away after menopause is also associated with greater risk. the good news is that the risk returns to baseline within several years after stopping ht. you should also be aware that combined ht can make it more difficult to read your mammogram (both while you're taking hormones and in the first years after stopping). as a result you might be called back for additional views or biopsy of suspicious areas. right now most experts recommend limiting ht to several years. the nams 2010 ht position statement ( www. menopause. org/psht10. pdf ) suggests that longer use is acceptable for a woman if she believes that the benefits outweigh the risks (especially if she's had trouble stopping therapy). the other condition includes women with low bone mass or osteoporosis who cannot tolerate osteoporosis drugs. the one exception to limiting ht to a few years is the woman who has had premature menopause either because of natural failure of her ovaries or surgical removal. in that case most experts are comfortable advising you to continue ht at least until the age of natural menopause about age 50 at which time you can reassess. if you've been taking hormones for a very long time you might want to start by discussing a lower dose. many clinicians now prescribe half the dose we used to use.
what are the risks of long term use of hormone replacement therapy?