Case in point. Counseling about hormone replacement therapy.

Mrs. S's case demonstrates the dilemmas that many women face at menopause regarding HRT. No clear answer to her question exists. Oncology nurses need to help women understand that taking HRT is a decision that is best made after carefully weighing the risks and benefits of therapy. Mrs. S needs to realize that she has some risk factors for heart disease, osteoporosis, breast cancer, and uterine cancer. Depending on her motivation, Mrs. S can modify some of the risk factors (e.g., reducing her weight and cholesterol). Smoking cessation also would reduce her risk for heart disease and, to a lesser extent, osteoporosis. Although her risk for developing breast cancer is higher than for a woman without a family history of breast cancer, she only has one relative who was older when she developed breast cancer. This risk factor in itself probably would not be enough to advise her against taking HRT. Additional testing may offer some clarification. If her breasts are difficult to examine or her mammograms are difficult to interpret, Mrs. S may feel that the risk of missing breast cancer early is too high to justify taking HRT. An abnormal endometrial biopsy also may make Mrs. S decide against taking HRT. BMD testing might help to better assess her risk for osteoporosis. If some bone loss has occurred before menopause, she may want to give more consideration to taking HRT or medications such as alendronate sodium to reduce her risk for an osteoporotic fracture. Women need to understand that, often, no best answer is available to the question of whether or not to take HRT. With every decision comes some consequences. An understanding of risk factors and ways to maximize cardiovascular, breast, endometrial, and bone health are important factors to consider when making an informed decision. Clearly, this is an area where oncology nurses can provide tremendous patient education and support to women making decisions about HRT.