American Medical Association Family Medical Guide - American Medical Association [572]
Hormone Therapy
To prevent the symptoms produced by falling estrogen levels during menopause, doctors have traditionally turned to hormone therapy. In addition to having the potential to prevent osteoporosis after menopause, hormone therapy may help reduce the risk of colon cancer. However, hormone therapy seems to increase the risk of breast cancer, heart attack, stroke, and blood clots in some women. Studies are being done to understand the link between reduced estrogen production and tooth loss and age-related macular degeneration (the most frequent cause of loss of vision in people over 50; see page 1046).
If you are considering hormone therapy, talk with your doctor about what the benefits and risks might be for you. Hormone therapy is available in the form of pills, skin patches, and vaginal creams. Most women take estrogen along with a progestin. Doctors recommend this hormone combination because estrogen given alone may slightly increase the risk of cancer of the uterus. (Because women who have had their uterus surgically removed cannot develop uterine cancer, there is no need for them to take progestin with the estrogen to reduce the risk of uterine cancer.)
Menopausal women taking the hormone combination sometimes temporarily resume monthly bleeding or have spotting. Bleeding usually stops within 6 to 12 months. Sometimes all it takes is a different dose of hormones to stop the bleeding. Some women experience breast tenderness, bloating, abdominal cramps, anxiety, irritability, or depression from hormone therapy.
There are medications other than hormone therapy that can help alleviate some menopausal symptoms. For example, water-based vaginal lubricants and estrogen-containing vaginal creams can help relieve vaginal dryness and reduce discomfort during sexual intercourse. Many effective drugs also are available that help maintain a woman’s bone density and prevent and treat osteoporosis without increasing the risk of uterine cancer, breast cancer, heart attack, or blood clots.
Breast Disorders
The primary function of the female breasts is to produce milk to feed an infant. The breasts also play a role in a woman’s sexuality. Breast sensitivity and sexual response vary among women, but most women’s breasts undergo a number of physiologic changes in response to sexual stimulation. In some women, hormonal fluctuations during the menstrual cycle make the breasts a little larger and tender before periods.
The size and shape of a woman’s breasts are determined primarily by genes. Most of the breast consists of fat, which is layered around milk glands, milk ducts, and supporting fibers. The nipple contains 15 to 20 tiny openings, which are the outlets of milk ducts or sebaceous (oil) glands. The sebaceous glands secrete an oily substance that lubricates and protects the skin. Around the nipple is a pigmented area called the areola, which can vary greatly in size, shape, and color from one woman to another. Small muscles behind the areola make the nipple erect when stimulated. The system of milk glands and ducts radiates out from the nipple.
The breast
A woman’s breasts consist mostly of fatty tissue surrounding a system of milk glands (called lobules), milk ducts, and connective tissue. The milk glands and ducts radiate out from the nipple. During pregnancy, the milk-producing glands become active. At about the time of childbirth, the milk glands secrete milk into the ducts, where it is stored until an infant needs it. A layer of muscle lies behind each breast.
Infection-fighting lymph nodes drain lymph fluids from the breast to three major areas—the armpit, the area just above the collarbone, and the area under the breastbone. The breasts can develop abnormal growths