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Breast
Special Topics
Hormonal Changes
Hormonal Supplementation
Hormonal Supplementation
Lauren Q. Chang Sen, MD; Wei Tse Yang, MBBS
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          TERMINOLOGY

          • Definitions

            • Hormone replacement therapy (HRT): Use of exogenous hormones to offset ↓ levels of estrogen &/or progesterone in postmenopausal women or after bilateral oophorectomy
            • Combination HRT: Estrogen (E) and progestin (P); may be sequential E+P (E daily with P added for 10-14 days every 4 weeks) or continuous E+P (E+P daily)
            • Gender reassignment transwomen (male to female): Antiandrogens plus estrogen

          IMAGING

          • General Features

            • Hormone Replacement Therapy

              DIFFERENTIAL DIAGNOSIS

                PATHOLOGY

                • General Features

                  CLINICAL ISSUES

                  • Hormone Replacement Therapy

                    DIAGNOSTIC CHECKLIST

                    • Consider

                      Selected References

                      1. Deli T et al: Hormone replacement therapy in cancer survivors - review of the literature. Pathol Oncol Res. ePub, 2019
                      2. Azam S et al: Hormone replacement therapy, mammographic density, and breast cancer risk: a cohort study. Cancer Causes Control. 29(6):495-505, 2018
                      3. Brooks JD et al: MRI background parenchymal enhancement, breast density and serum hormones in postmenopausal women. Int J Cancer. 143(4):823-830, 2018
                      4. Chester RC et al: What the Women's Health Initiative has taught us about menopausal hormone therapy. Clin Cardiol. 41(2):247-52, 2018
                      5. de Blok CJM et al: Breast Development in Transwomen After 1 Year of Cross-Sex Hormone Therapy: Results of a Prospective Multicenter Study. J Clin Endocrinol Metab. 103(2):532-538, 2018
                      6. Heller SL et al: Hormonal Effects on Breast Density, Fibroglandular Tissue, and Background Parenchymal Enhancement. Radiographics. 38(4):983-996, 2018
                      7. Andersson TM et al: Mammographic Density Reduction as a Prognostic Marker for Postmenopausal Breast Cancer: Results Using a Joint Longitudinal-Survival Modeling Approach. Am J Epidemiol. 186(9):1065-1073, 2017
                      8. Byrne C et al: Mammographic density change with estrogen and progestin therapy and breast cancer risk. J Natl Cancer Inst. 109(9), 2017
                      9. Lobo RA: Hormone-replacement therapy: current thinking. Nat Rev Endocrinol. 13(4):220-231, 2017
                      10. Manson JE et al: Menopausal Hormone Therapy and Long-term All-Cause and Cause-Specific Mortality: The Women's Health Initiative Randomized Trials. JAMA. 318(10):927-938, 2017
                      11. McNeil M: Menopausal Hormone Therapy: Understanding Long-term Risks and Benefits. JAMA. 318(10):911-913, 2017
                      12. Hodis HN et al: Vascular Effects of Early versus Late Postmenopausal Treatment with Estradiol. N Engl J Med. 374(13):1221-31, 2016
                      13. Zhu L et al: Effect of hormone therapy on the risk of bone fractures: a systematic review and meta-analysis of randomized controlled trials. Menopause. 23(4):461-70, 2016
                      14. Hruska CB et al: Background parenchymal uptake during molecular breast imaging and associated clinical factors. AJR Am J Roentgenol. 204(3):W363-70, 2015
                      15. Harman SM et al: Arterial imaging outcomes and cardiovascular risk factors in recently menopausal women: a randomized trial. Ann Intern Med. 161(4):249-60, 2014
                      16. Fahlén M et al: Hormone replacement therapy after breast cancer: 10 year follow up of the Stockholm randomised trial. Eur J Cancer. 49(1):52-9, 2013
                      17. Manson JE et al: Menopausal hormone therapy and health outcomes during the intervention and extended poststopping phases of the Women's Health Initiative randomized trials. JAMA. 310(13):1353-68, 2013
                      18. King V et al: Impact of menopausal status on background parenchymal enhancement and fibroglandular tissue on breast MRI. Eur Radiol. 22(12):2641-7, 2012
                      19. King V et al: Background parenchymal enhancement at breast MR imaging and breast cancer risk. Radiology. 260(1):50-60, 2011
                      20. Chlebowski RT et al: Estrogen plus progestin and breast cancer incidence and mortality in postmenopausal women. JAMA. 304(15):1684-92, 2010
                      21. Kerlikowske K et al: Breast cancer risk by breast density, menopause, and postmenopausal hormone therapy use. J Clin Oncol. 28(24):3830-7, 2010
                      22. Untch M et al: Clinical practice decisions in endocrine therapy. Cancer Invest. 28 Suppl 1:4-13, 2010
                      23. Chlebowski RT et al: Breast cancer after use of estrogen plus progestin in postmenopausal women. N Engl J Med. 360(6):573-87, 2009
                      24. Holmberg L et al: Increased risk of recurrence after hormone replacement therapy in breast cancer survivors. J Natl Cancer Inst. 100(7):475-82, 2008
                      25. Aiello EJ et al: Do breast cancer risk factors modify the association between hormone therapy and mammographic breast density? (United States). Cancer Causes Control. 17(10):1227-35, 2006
                      26. Palomares MR et al: Mammographic density correlation with Gail model breast cancer risk estimates and component risk factors. Cancer Epidemiol Biomarkers Prev. 15(7):1324-30, 2006
                      27. Topal NB et al: Effects of hormone replacement therapy regimens on mammographic breast density: the role of progestins. J Obstet Gynaecol Res. 32(3):305-8, 2006
                      28. Delille JP et al: Hormone replacement therapy in postmenopausal women: breast tissue perfusion determined with MR imaging--initial observations. Radiology. 235(1):36-41, 2005
                      29. Anderson GL et al: Effects of conjugated equine estrogen in postmenopausal women with hysterectomy: the Women's Health Initiative randomized controlled trial. JAMA. 291(14):1701-12, 2004
                      30. Pfleiderer SO et al: Changes in magnetic resonance mammography due to hormone replacement therapy. Breast Cancer Res. 6(3):R232-8, 2004
                      31. Beral V; Million Women Study Collaborators: Breast cancer and hormone-replacement therapy in the Million Women Study. Lancet. 362(9382):419-27, 2003
                      32. Carney PA et al: Individual and combined effects of age, breast density, and hormone replacement therapy use on the accuracy of screening mammography. Ann Intern Med. 138(3):168-75, 2003
                      33. Rossouw JE et al: Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women's Health Initiative randomized controlled trial. JAMA. 288(3):321-33, 2002
                      34. Colacurci N et al: Effects of a short-term suspension of hormone replacement therapy on mammographic density. Fertil Steril. 76(3):451-5, 2001
                      35. Colacurci N et al: Effects of different types of hormone replacement therapy on mammographic density. Maturitas. 40(2):159-64, 2001
                      36. Erel CT et al: Mammographic density increase in women receiving different hormone replacement regimens. Maturitas. 40(2):151-7, 2001
                      37. Rutter CM et al: Changes in breast density associated with initiation, discontinuation, and continuing use of hormone replacement therapy. JAMA. 285(2):171-6, 2001
                      38. Sendağ F et al: Mammographic density changes during different postmenopausal hormone replacement therapies. Fertil Steril. 76(3):445-50, 2001
                      39. Kavanagh AM et al: Hormone replacement therapy and accuracy of mammographic screening. Lancet. 355(9200):270-4, 2000
                      40. Schairer C et al: Menopausal estrogen and estrogen-progestin replacement therapy and breast cancer risk. JAMA. 283(4):485-91, 2000
                      41. Lundström E et al: Mammographic breast density during hormone replacement therapy: differences according to treatment. Am J Obstet Gynecol. 181(2):348-52, 1999
                      42. Harvey JA et al: Short-term cessation of hormone replacement therapy and improvement of mammographic specificity. J Natl Cancer Inst. 89(21):1623-5, 1997
                      43. Marugg RC et al: Mammographic changes in postmenopausal women on hormonal replacement therapy. Eur Radiol. 7(5):749-55, 1997
                      44. Persson I et al: Effect of estrogen and estrogen-progestin replacement regimens on mammographic breast parenchymal density. J Clin Oncol. 15(10):3201-7, 1997
                      45. Thurfjell EL et al: Screening mammography: sensitivity and specificity in relation to hormone replacement therapy. Radiology. 203(2):339-41, 1997
                      46. Cyrlak D et al: Mammographic changes in postmenopausal women undergoing hormonal replacement therapy. AJR Am J Roentgenol. 161(6):1177-83, 1993
                      Related Anatomy
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                      Related Differential Diagnoses
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                      References
                      Tables

                      Tables

                      KEY FACTS

                      • Terminology

                        • Imaging

                          • Top Differential Diagnoses

                            • Clinical Issues

                              TERMINOLOGY

                              • Definitions

                                • Hormone replacement therapy (HRT): Use of exogenous hormones to offset ↓ levels of estrogen &/or progesterone in postmenopausal women or after bilateral oophorectomy
                                • Combination HRT: Estrogen (E) and progestin (P); may be sequential E+P (E daily with P added for 10-14 days every 4 weeks) or continuous E+P (E+P daily)
                                • Gender reassignment transwomen (male to female): Antiandrogens plus estrogen

                              IMAGING

                              • General Features

                                • Hormone Replacement Therapy

                                  DIFFERENTIAL DIAGNOSIS

                                    PATHOLOGY

                                    • General Features

                                      CLINICAL ISSUES

                                      • Hormone Replacement Therapy

                                        DIAGNOSTIC CHECKLIST

                                        • Consider

                                          Selected References

                                          1. Deli T et al: Hormone replacement therapy in cancer survivors - review of the literature. Pathol Oncol Res. ePub, 2019
                                          2. Azam S et al: Hormone replacement therapy, mammographic density, and breast cancer risk: a cohort study. Cancer Causes Control. 29(6):495-505, 2018
                                          3. Brooks JD et al: MRI background parenchymal enhancement, breast density and serum hormones in postmenopausal women. Int J Cancer. 143(4):823-830, 2018
                                          4. Chester RC et al: What the Women's Health Initiative has taught us about menopausal hormone therapy. Clin Cardiol. 41(2):247-52, 2018
                                          5. de Blok CJM et al: Breast Development in Transwomen After 1 Year of Cross-Sex Hormone Therapy: Results of a Prospective Multicenter Study. J Clin Endocrinol Metab. 103(2):532-538, 2018
                                          6. Heller SL et al: Hormonal Effects on Breast Density, Fibroglandular Tissue, and Background Parenchymal Enhancement. Radiographics. 38(4):983-996, 2018
                                          7. Andersson TM et al: Mammographic Density Reduction as a Prognostic Marker for Postmenopausal Breast Cancer: Results Using a Joint Longitudinal-Survival Modeling Approach. Am J Epidemiol. 186(9):1065-1073, 2017
                                          8. Byrne C et al: Mammographic density change with estrogen and progestin therapy and breast cancer risk. J Natl Cancer Inst. 109(9), 2017
                                          9. Lobo RA: Hormone-replacement therapy: current thinking. Nat Rev Endocrinol. 13(4):220-231, 2017
                                          10. Manson JE et al: Menopausal Hormone Therapy and Long-term All-Cause and Cause-Specific Mortality: The Women's Health Initiative Randomized Trials. JAMA. 318(10):927-938, 2017
                                          11. McNeil M: Menopausal Hormone Therapy: Understanding Long-term Risks and Benefits. JAMA. 318(10):911-913, 2017
                                          12. Hodis HN et al: Vascular Effects of Early versus Late Postmenopausal Treatment with Estradiol. N Engl J Med. 374(13):1221-31, 2016
                                          13. Zhu L et al: Effect of hormone therapy on the risk of bone fractures: a systematic review and meta-analysis of randomized controlled trials. Menopause. 23(4):461-70, 2016
                                          14. Hruska CB et al: Background parenchymal uptake during molecular breast imaging and associated clinical factors. AJR Am J Roentgenol. 204(3):W363-70, 2015
                                          15. Harman SM et al: Arterial imaging outcomes and cardiovascular risk factors in recently menopausal women: a randomized trial. Ann Intern Med. 161(4):249-60, 2014
                                          16. Fahlén M et al: Hormone replacement therapy after breast cancer: 10 year follow up of the Stockholm randomised trial. Eur J Cancer. 49(1):52-9, 2013
                                          17. Manson JE et al: Menopausal hormone therapy and health outcomes during the intervention and extended poststopping phases of the Women's Health Initiative randomized trials. JAMA. 310(13):1353-68, 2013
                                          18. King V et al: Impact of menopausal status on background parenchymal enhancement and fibroglandular tissue on breast MRI. Eur Radiol. 22(12):2641-7, 2012
                                          19. King V et al: Background parenchymal enhancement at breast MR imaging and breast cancer risk. Radiology. 260(1):50-60, 2011
                                          20. Chlebowski RT et al: Estrogen plus progestin and breast cancer incidence and mortality in postmenopausal women. JAMA. 304(15):1684-92, 2010
                                          21. Kerlikowske K et al: Breast cancer risk by breast density, menopause, and postmenopausal hormone therapy use. J Clin Oncol. 28(24):3830-7, 2010
                                          22. Untch M et al: Clinical practice decisions in endocrine therapy. Cancer Invest. 28 Suppl 1:4-13, 2010
                                          23. Chlebowski RT et al: Breast cancer after use of estrogen plus progestin in postmenopausal women. N Engl J Med. 360(6):573-87, 2009
                                          24. Holmberg L et al: Increased risk of recurrence after hormone replacement therapy in breast cancer survivors. J Natl Cancer Inst. 100(7):475-82, 2008
                                          25. Aiello EJ et al: Do breast cancer risk factors modify the association between hormone therapy and mammographic breast density? (United States). Cancer Causes Control. 17(10):1227-35, 2006
                                          26. Palomares MR et al: Mammographic density correlation with Gail model breast cancer risk estimates and component risk factors. Cancer Epidemiol Biomarkers Prev. 15(7):1324-30, 2006
                                          27. Topal NB et al: Effects of hormone replacement therapy regimens on mammographic breast density: the role of progestins. J Obstet Gynaecol Res. 32(3):305-8, 2006
                                          28. Delille JP et al: Hormone replacement therapy in postmenopausal women: breast tissue perfusion determined with MR imaging--initial observations. Radiology. 235(1):36-41, 2005
                                          29. Anderson GL et al: Effects of conjugated equine estrogen in postmenopausal women with hysterectomy: the Women's Health Initiative randomized controlled trial. JAMA. 291(14):1701-12, 2004
                                          30. Pfleiderer SO et al: Changes in magnetic resonance mammography due to hormone replacement therapy. Breast Cancer Res. 6(3):R232-8, 2004
                                          31. Beral V; Million Women Study Collaborators: Breast cancer and hormone-replacement therapy in the Million Women Study. Lancet. 362(9382):419-27, 2003
                                          32. Carney PA et al: Individual and combined effects of age, breast density, and hormone replacement therapy use on the accuracy of screening mammography. Ann Intern Med. 138(3):168-75, 2003
                                          33. Rossouw JE et al: Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women's Health Initiative randomized controlled trial. JAMA. 288(3):321-33, 2002
                                          34. Colacurci N et al: Effects of a short-term suspension of hormone replacement therapy on mammographic density. Fertil Steril. 76(3):451-5, 2001
                                          35. Colacurci N et al: Effects of different types of hormone replacement therapy on mammographic density. Maturitas. 40(2):159-64, 2001
                                          36. Erel CT et al: Mammographic density increase in women receiving different hormone replacement regimens. Maturitas. 40(2):151-7, 2001
                                          37. Rutter CM et al: Changes in breast density associated with initiation, discontinuation, and continuing use of hormone replacement therapy. JAMA. 285(2):171-6, 2001
                                          38. Sendağ F et al: Mammographic density changes during different postmenopausal hormone replacement therapies. Fertil Steril. 76(3):445-50, 2001
                                          39. Kavanagh AM et al: Hormone replacement therapy and accuracy of mammographic screening. Lancet. 355(9200):270-4, 2000
                                          40. Schairer C et al: Menopausal estrogen and estrogen-progestin replacement therapy and breast cancer risk. JAMA. 283(4):485-91, 2000
                                          41. Lundström E et al: Mammographic breast density during hormone replacement therapy: differences according to treatment. Am J Obstet Gynecol. 181(2):348-52, 1999
                                          42. Harvey JA et al: Short-term cessation of hormone replacement therapy and improvement of mammographic specificity. J Natl Cancer Inst. 89(21):1623-5, 1997
                                          43. Marugg RC et al: Mammographic changes in postmenopausal women on hormonal replacement therapy. Eur Radiol. 7(5):749-55, 1997
                                          44. Persson I et al: Effect of estrogen and estrogen-progestin replacement regimens on mammographic breast parenchymal density. J Clin Oncol. 15(10):3201-7, 1997
                                          45. Thurfjell EL et al: Screening mammography: sensitivity and specificity in relation to hormone replacement therapy. Radiology. 203(2):339-41, 1997
                                          46. Cyrlak D et al: Mammographic changes in postmenopausal women undergoing hormonal replacement therapy. AJR Am J Roentgenol. 161(6):1177-83, 1993