Hormone Replacement Therapy, pt 2

Even when there has been an increased risk of breast cancer attributed to hormone use, the increase is virtually miniscule.

ASK THE DOCTOR: Hormone Replacement Th erapy, pt 2

BY STEVE LASATER, M.D.

CLICK HERE TO READ PART 1 OF “ASK THE DOCTOR: HORMONE REPLACEMENT THERAPY,” FEATURED IN THE APRIL ISSUE OF WOMEN’S LIFESTYLE MAGAZINE

DEAR KATHY,

One study by Kramer et al. found that progesterone stimulated a non-malignant breast cancer cell line less than Provera® and other progestins, and concluded by saying, “ erefore, the choice of progestin may be important in terms of in uencing a possible breast cancer risk.” Another study by Ghatge et al., looking at the e ect of MPA (Provera®) in breast cancer cells in vitro, concluded, “Our comparison of the gene regulatory pro les of MPA and progesterone suggests that, for physiologic hormone replacement therapy, the actions of MPA do not mimic those of endogenous progesterone alone.”

In vivo evidence is another type of evidence – in living persons. In one randomized, double-blind study of women undergoing breast surgery for benign conditions, Foidart et al. found that those who applied topical progesterone to the breast for 14 days before surgery had a decrease in the stimulation of breast cells in the excised tissue.  is is direct molecular biological evidence that progesterone and Provera® are di erent, and thus the associated cancer risks are di erent as well. In Europe, transdermal estradiol and progesterone are used more frequently than Premarin® and Provera®. In another study, De Lignieres et al. followed a cohort of 3,175 French women who used mostly transdermal estradiol, and progestins other than Provera®, for an average of 8.9 years; they found that there was no increased risk of breast cancer.

 ese studies are part of the growing evidence that the class-e ect concept that considers all progestins to have exactly the same e ects in all tissues is untenable. If your gynecologist or internist makes a class-e ect argument when he or she tells you there is no di erence between progesterone and Provera® (I often hear, “It is progesterone”), show him or her these studies. (If you would like to have the actual references cited, please write to me and I will gladly forward them to you.)

2. Even when there has been an increased risk of breast cancer attributed to hormone use, the increase is virtually miniscule.  e International Menopause Society (IMS) is the largest menopause society in the world and was the lone voice of reason when the initial results from the Women’s Health Initiative Study were released in 2002 – the study which was hyped as showing an increased risk of cancer from “hormones.” Had the IMS’s incisive analysis of the data been heeded by the media, many women would have been spared the needless turmoil that cessation of HRT caused in their lives. Here is what the IMS has stated:

 e risk of breast cancer attributable to MHT (menopausal hormone therapy) is rare. It equates to an incidence of <1.0 per 1000 women per year of use.  is is similar or lower than the increased risk associated with common factors such as sedentary lifestyle, obesity and alcohol consumption.  e risk may decrease after treatment is stopped, but data are inconsistent. (from the International Menopause Society, in Revised Global Consensus Statement on Menopausal Hormone  erapy, 20 June 2016)

3. Other cancers than breast cancer have been shown to be signi cantly LESS likely in women taking hormone replacement.

Colorectal Cancer is the second most common cancer in women (after breast cancer). Evidence from the Women’s Health Initiative and other trials suggests that current HRT users have a 40% reduction in colorectal cancers.  is certainly needs to be factored into the “hormones and cancer risk” equation.

4.  ere are numerous other bene ts to bio-identical hormone replacement therapy (HRT). It should also be pointed out that if the bio-identical HRT consists of estradiol applied on the skin (transdermal) or under the skin (subcutaneous pellets), then most of the other adverse events associated with oral conjugated equine estrogen (Premarin®) such as blood clots, strokes, gall bladder disease, and increased triglycerides and C-reactive protein, are likely to be eliminated as well.  is results in a risk-bene t equation that is quite bene cial for most women undergoing the menopausal transition as well as for continued, long-term therapy. But even oral hormone replacement has considerable bene ts, as shown by a study published in the British Medical Journal in 2012, in which over 1,000 women in Denmark who had recently undergone menopause were randomized into two groups, serving either as the treatment group, who were given estradiol and a progestin, or the control group. After being followed for ten years, those women who had received the hormone replacement therapy showed a signi cantly reduced risk of heart failure, heart attack, and of overall mortality, without any apparent increase in the risk of blood clot, stroke, or cancer! When one also  gures in the improved quality of life typically experienced by women receiving hormone replacement therapy – dramatic relief from hot  ashes and night sweats, improved sexual wellbeing, and reduction in fatigue, to name just a few – the decision of whether or not to take hormone replacement therapy should for many post-menopausal women be considered a “no-brainer.”