There's another potential side effect of long term use of hormone replacement therapy, and this one may come as a surprise. Yes, it's cancer, but not the kind you might expect.
When Suretta Must first started having hot flashes, her doctor suggested HRT, but Suretta was leery.
"I decided not to take hormones because of the larger risk of breast cancer and the fear of weight gain," said Must.
Turns out breast cancer isn't the only cancer risk associated with long-term use of estrogen plus progestin.
"Women who received that therapy for greater than 10 years had a significant increase in risk of developing lung cancer. Their risk increased by about 50 percent," said Dr. Jason Chien, Seattle Cancer Alliance.
And here's the unexpected twist. Chien, who co-authored the study, says that the increased risk for lung cancer also applies to women who've never smoked. That's right, never smoked and who aren't even on the radar for lung cancer.
What should women do if they've been using HRT for more than ten years?
"Someone who's in that group might be more vigilant about their respiratory symptoms, things like a persistent cough, sputum production, maybe even some blood in their sputum, chest pain," said Chien.
And tell their doctor, since early detection is key. A CT scan shows a stage one disease lung cancer, which can be easily treated.
An earlier study showed that women diagnosed with lung cancer while taking HRT have a higher risk of dying from their cancer.
"If you gather all those data up, it basically tells us we should not be using hormonal therapy long term," said Chien.
At the same time, smoking still poses a bigger threat for lung cancer than HRT does. Of course women who combine the two put themselves at even greater risk.
The study appears in the Journal of Clinical Oncology.