There has been media coverage of a study by Professor Emily Banks that says HRT increases menopausal women’s risk of breast cancer (BC). This comes up frequently, as women are naturally concerned about any connection between the two. This means I will spend the next month reassuring my patients that the way I do it is very safe, and I will explain the reason I can say that below.
The study published in today’s media had a number of problems with it – they used mainly synthetic progestogen, and not natural progesterone. I have known (from many published studies, so it is no secret) that the synthetic progesterones increase women’s rick of BC. Natural progesterone does not. So why would any doctor give it to menopausal women? Beats me. Ask them for an explanation.
Secondly, most of the hormones used were in pill form. We have known for many years the HRT must be given transdermally (creams, patches or troches), and not as a pill. So why do doctors use oral forms of HRT (Like Livial, Xyvion, estalis, Kliovance, Kliogest, Femoston, Progynova, Premarin) Beats me. Ask them for an explanation.
Third factor – using one size fit all means many women get the wrong dose of hormone – tailoring the dose has to be better, so women get the lowest dose that works for them.
Personal experience – I have been using these BHRT for the last 25 years, in over 4500 women, and doing a statistical study of these women, I get about 4% BC incidence. BC occurs in about 13% of Australian women, so I know that there is no increase in BC in the women I treat – in fact the opposite. Unfortunately some of my patients do end up with BC – but it is below the national incidence.
Now lets look at the opposite – lives saved. Most women die from heart disease (estimate about 50%), not BC. HRT reduces women’s risk of heart disease significantly, so it actually saves lives. Then there is the quality of life issues, relationships saved and general well being on HRT.
Here are the relevant articles which I have published before: note they come from impeccable sources: You can find anything on the internet, so information should only come from respected medical journals, internationally respected researchers, and grade 1 universities.
Climacteric. 2012 Apr;15 Suppl 1:3-10.
What’s new in hormone replacement therapy: focus on transdermal estradiol and micronized progesterone.
Simon JA.
Source
Department of Obstetrics and Gynecology, George Washington University, Washington, DC 20036, USA.
Abstract
The original conclusions of the Women’s
Health Initiative study have been questioned as a result of the
availability of age-stratified data. Initial concerns regarding the risk
of coronary heart disease (CHD) in association with the use of hormone
replacement therapy (HRT) have been replaced with concerns regarding
thromboembolic disease, encompassing venous thromboembolism (VTE),
particularly in younger postmenopausal women, and stroke, particularly
in older women. The original publication of the study results led to a
dramatic decrease in the use of oral HRT; however, the use of
transdermal HRT has increased over recent years.
Guidelines from the North
American Menopause Society, the Endocrine Society, the International
Menopause Society, and specific guidelines from the Menopause and
Andropause Society for the management of menopausal women with a
personal or family history of VTE all contain positive statements
regarding both transdermal estradiol and micronized progesterone.
Unlike oral estrogens,
transdermal estradiol has been shown not to increase the risk of VTE, or
stroke (doses ≤ 50 μg), and to confer a significantly lower risk for
gallbladder disease. Unlike some progestogens, progesterone is also not
associated with an increased risk of VTE, or with an increased risk of
breast cancer. Based on these data, which are now included
in the guidelines, the use of transdermal estradiol and
micronized progesterone could reduce or possibly even negate the excess
risk of VTE, stroke, cholecystitis, and possibly even breast cancer
associated with oral HRT use
They reviewed all the guidelines form the
major medical bodies that deal with hormones, and concluded that using
transdermal oestrogen and micronised progesterone is the safest form of
HRT. Micronised is the form of natural progesterone used in
Bioidentical HRT. This is not to be confused with progestogens, which is
used mainly in the synthetic forms of HRT Progestogens largely are
known as Provera, {Medroxyprgesterone acetate- MPA: or
Norethisterone (Primolut-N).
This is the most recent medical publication re safety of HRT:Menopause. 2016 Jul 25. [Epub ahead of print]
Reduced risk of breast cancer mortality in women using postmenopausal hormone therapy: a Finnish nationwide comparative study.
Mikkola TS1, Savolainen-Peltonen H, Tuomikoski P, Hoti F, Vattulainen P, Gissler M, Ylikorkala O.
- 11Department of Obstetrics and Gynecology, University of
Helsinki and Helsinki University Hospital, Helsinki, Finland 2Folkhälsan
Research Center, Biomedicum, Helsinki, Finland 3EPID Research Oy,
Espoo, Finland 4Information Services Department, National Institute for
Health and Welfare, Helsinki, Finland.
Abstract
OBJECTIVE:
Data are controversial on the impact of postmenopausal hormone
therapy (HT) on breast cancer mortality. We analyzed nationwide Finnish
data on breast cancer mortality risk in women using HT consisting of
estradiol-only therapy (ET) or estrogen-progestogen therapy (EPT).
METHODS:
In total, 489,105 women using HT in 1994 to 2009, traced from the
nationwide reimbursement register, were followed from the HT initiation
(3.3 million cumulative exposure years) to breast cancer death
(n = 1,578 women). The observed deaths were compared with those in the
age-standardized background population.
RESULTS:
The breast cancer mortality risk was reduced in all HT users with
exposure for at most 5 years (standardized mortality ratio 0.56; CI
0.52-0.60), more than 5 to 10 years (0.46; 0.41-0.51), or more than 10
years (0.62; 0.56-0.68). A significantly larger risk reduction was detected in the 50 to 59 years age group
(0.33; 0.29-0.37) compared with 60 to 69 (0.64; 0.59-0.70) or 70 to 79
(0.78; 0.69-0.87) years age groups. The death risk reductions in ET
users tended to be larger in all age groups compared with EPT users,
with a significant difference only in the 70 to 79 years age group
(0.66; 0.57-0.76 vs 0.88; 0.77-1.00). The age at HT initiation,
regardless whether ET or EPT, showed no association with breast cancer
mortality.
CONCLUSIONS:
In the Finnish unselected population, breast cancer is
fatal in 1 of 10 patients. Our data imply that this risk is prevalent in
1 of 20 patients with history of HT use. This is an important message
for women considering or already using HT.Menopause. 2015 Sep;22(9):976-83. doi: 10.1097/GME.0000000000000450.
Estradiol-based postmenopausal hormone therapy and risk of cardiovascular and all-cause mortality.
Mikkola TS1, Tuomikoski P, Lyytinen H, Korhonen P, Hoti F, Vattulainen P, Gissler M, Ylikorkala O.
Abstract
OBJECTIVE:
Data on the health benefits and risks of postmenopausal hormone
therapy (HT) are derived mainly from the use of conjugated equine
estrogens. Estradiol-based regimens may have a different risk-benefit
profile. We evaluated the risk of death caused by coronary heart disease
(CHD), stroke, or any disease among users of estradiol-based HT
regimens in a nationwide study in Finland.
METHODS:
A total of 489,105 women who used HT from 1994 to 2009 (3.3 million
HT exposure years), as indicated in the nationwide reimbursement
register and the national Cause of Death Register, were followed. A
total of 28,734 HT users died during follow-up; among the deaths, 3,843
were caused by CHD and 2,464 were caused by stroke. Mortality risk in HT
users with varying duration of exposure (≤1 y, >1 to 3 y, >3 to 5
y, >5 to 10 y, or >10 y) was compared with that in an age-matched
background population.
RESULTS:
Risk of CHD death was significantly reduced by 18% to 54% in HT users
and was positively related to HT exposure time. Risk of stroke death
was also reduced by 18% to 39%, but this reduction was not clearly
related to HT exposure time. Risk of all-cause mortality was reduced in
HT users by 12% to 38%, almost in linear relationship with duration of
exposure. All these risk reductions were comparable in women initiating
HT before age 60 years and women initiating HT at age 60 years or older.
CONCLUSIONS:
In absolute terms, the risk reductions mean 19 fewer CHD deaths and 7 fewer stroke deaths per 1,000 women using any HT for at least 10 years.
Am J Public Health. 2013 Sep;103(9):1583-8. doi: 10.2105/AJPH.2013.301295. Epub 2013 Jul 18.
The mortality toll of estrogen avoidance: an analysis of excess deaths among hysterectomized women aged 50 to 59 years.
Sarrel PM1, Njike VY, Vinante V, Katz DL.
1
Departments of Obstetrics and Gynecology and Psychiatry, Yale
University School of Medicine, New Haven, CT, USA.
philip.sarrel@yale.edu
Abstract
OBJECTIVES:
We examined the effect of estrogen avoidance on mortality rates among hysterectomized women aged 50 to 59 years.
METHODS:
We derived a formula to relate the excess mortality among
hysterectomized women aged 50 to 59 years assigned to placebo in the
Women’s Health Initiative randomized controlled trial to the entire
population of comparable women in the United States, incorporating the
decline in estrogen use observed between 2002 and 2011.
RESULTS:
Over a 10-year span, starting in 2002, a minimum of 18 601 and as
many as 91 610 postmenopausal women died prematurely because of the
avoidance of estrogen therapy (ET).
CONCLUSIONS:
ET in younger postmenopausal women is associated with a decisive
reduction in all-cause mortality, but estrogen use in this population is
low and continuing to fall. Our data indicate an associated annual
mortality toll in the thousands of women aged 50 to 59 years. Informed
discussion between these women and their health care providers about the
effects of ET is a matter of considerable urgency
Dr Colin Holloway 