One of my favorite topics is back in the news: the relationship between postmenopausal hormone therapy—what we used to call hormone replacement therapy (HRT)—and breast cancer.

As you probably recall, in July 2002 a large randomized study called the Women’s Health Initiative was stopped prematurely found that the risk of taking menopausal hormones outweighed any benefits. Virtually overnight, the number of women taking hormones to treat menopausal symptoms dropped dramatically. And then something incredible occurred: the incidence of breast cancer went down 15%. In other words, 15% fewer breast cancers were diagnosed in one year alone!

We’ve continued to see a decrease in breast cancer incidence over the past five years. And this decrease also has been seen in other countries besides the US. Yet, the pro-hormone folks have continued to argue that we shouldn’t jump to conclusions, as the reason for the decrease in breast cancer incidence could have been due to a decrease in the number of women who were getting mammograms.

But a study published this week in the New England Journal of Medicine has confirmed that it wasn’t a decrease in mammograms that decreased breast cancer incidence. It was stopping HRT. As the researchers explain, “the increased risk of breast cancer associated with estrogen-plus-progestin therapy declined markedly soon after discontinuation of the therapy and was unrelated to a change in the use of mammography.”

Furthermore, a second study that came out this week found that menopausal hormones (estrogen plus a progestin) doubled the risk of lobular cancer and increased the risk of ductal cancer by 75%. Furthermore, the longer a woman took hormones, the greater the risk. For ductal cancer, the risk doubled at about ten years, while for lobular cancer the risk doubled within the first five years. The use of estrogen alone (which is taken by women who no longer have a uterus) also increased breast cancer risk, but only by 50% after ten years.

The good news is that there did appear to be a safe period in which women can be on hormones and not experience an increased breast cancer risk. But that “safe” period is only about two years. Both studies also found that the increased risk disappeared within two years of women stopping the drugs.

Menopause is programmed into our bodies. We need high levels of hormones to reproduce, and then, when we reach menopause, our hormones shift down to a safer level. The bottom-line has been reinforced: Artificially maintaining higher levels of hormones is not good for our health.

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19 Responses to Menopausal Hormones—Back in the News

  1. So we know HRT is bad for us, but do the Bioidentical Hormones fall under the same catagory? Seems to be on all the talk shows of late, well Oprah’s-Summers/Dr. Northrup/Dr.Phills wife…is there anything safe out there to help balance us as we age – really?

  2. Lauran says:

    I took HRT (Estrogen plus progestin) from 1995 to 2002, stopping when the findings from the Women’s Health Initiative came out. After 2 years without HRT I chose to begin taking it again because my menopausal symptoms were still very annoying. My decision was made based on my having no known risk factors for breast cancer and because I wanted to improve my quality of life by minimizing my menopausal symptoms. Sadly, I was diagnosed with DCIS only two weeks ago and now I must begin the journey that so many women have taken, perhaps needlessly.

  3. The real problem in HRT is using the cookie cutter approach. We are each uniquely different—-a beautiful reality. There are now 24 hr. urine profiles being used in Europe and some practices in America that do not require a blood draw to give each woman new wisdom on the levels she produces endogenously, eats or consumes exogenously which constitute her unique biological make-up. Armed with this information, she is empowered to make more informed healthcare decisions about how organic foods, birth control, postmenopausal HRT and bioidentical hormones can benefit her and provide a quality of life. Why should Europe be 30 years ahead?

  4. Hena says:

    I have the same question as Michele Caples: what about the bioidentical hormones?

  5. martha carpenter says:

    I have an extremely healthy lifestyle via, diet and exercise. Extremely low risk for breast cancer in the family. I was on bioidentical estrodial and progesterin for 4 yrs. I was just diagnosed with breast cancer. I had a lumectomy and am looking at continued treatment of radiation and chemo. This is so against how I have lived my life for more than 40 yrs (I am 57). Severe Menopausal symptoms are returned. What are the alternatives to traditional medicine beyond the surgery for treatment of this cancer?

  6. Nancy says:

    I live a mostly healthy life style, no cancer history in family. I am 67, white,tall and skinny. I took prempro starting around age 50, for menopausal symptoms. 4 years ago I reduced the dosage by half,to support bone health. My last mammogram was in 2003, and I halted them because several false readings drove me crazy. Found the lump myself (left breast)in November 2008: turned out to be stage 1 cancer, one ductal (1.4 cm) the other lobular (.4cm). I’ve had two lumpectomies, (one to clear margins) 2 sampled nodes, all clear. I am not taking radiation,(will check myself regularly and resume mammograms) but will struggle through Tamoxifen. I am hoping that stopping the hormones will have a positive impact.

  7. I am a 57 year old woman who has been on Prempro over 5 years. I started taking prempro because I was bleeding excessivly, with at least 2 periods a month. I also had a lot of clots in the blood.
    When I started Prempro, not only did it stop my periods and hot flashes, it helped prevent migraines, which I had chronically. At that time, I didn’t think I had any family history of breast cancer. My 54 year old sister was just operated on for stage 3 breast cancer. I’m now worried about HRT. Should I stop? I also found out I have some great aunts who had breast cancer and died from it.

  8. Lynne Slim says:

    I need to ask Dr. Susan Love an important question. I think I read in Dr. Love’s book that the Million Women Study (in the U.K.) looked at women who were taking all kinds of hormones~ synthetic and bioidentical. I’ve been in the middle of a disagreement with someone who is telling me that bioidentical hormones are safe. I’ve cited the Million Women Study because I understand that some of the women in this study were taking so called “natural” or bioidentical hormones. How can I find out for sure? Is there anyone I can talk to at Oxford University who can confirm this for me? Thanks in advance.

  9. Vaginal Hysterectomy, took Premarin. I was diagnosed in year 2000 with Stage 2 Infiltrating Lobular Carcinoma-in-situ, had a Lumpectomy, 20 nodes removed and were clean. Treatment was Adriamycin & Cytoxan 4 treatments, radiation 33. Tamoxifen, & Aromisin. Right arm Lymphedima, many treatments, hospitalized for Cellulitis and use a pump. I am feeling better but carry alot of my weight in stomach. Do I need to have the salvia test to determine lack of hormones? Changes of reoccurence? Thank you for any help you can give me…….Rebecca

  10. Maryellen Keating says:

    I went through an early menopause at age 38 and was encouraged to start PREMPRO. I remained on this HRT for 10 years and then discontinued it. I continued regular Mammograms each year. In October of 2006 I had a mammogram that due to schedule conflicts, was only 9 months after the previous one. It was discovered that I had Invasive Ductal Carcinoma. I had a lumpectomy, chemo and radiation, and am now on Femara.
    I have been told that HRT does not CAUSE cancer, but that if you develop ER/PR+ cancer, that the hormones “feed” it. Is this true?

  11. Jan Pedersen says:

    I had Invasive Ductal Carcinoma but it was classified as “triple negative”. Does this mean that the 18 years I was on HRT did not contribute to my cancer?

  12. Barb Wills says:

    I am curious – with all the articles I have read here, I hear no mention of bioidentical progesterone in physiological amounts (very important). Dr. John Lee, in his three books, “What Your Doctor Will NOT Tell You About (1)Menopause, (2) Premenopause and (3) Breast Cancer is a proponent of this. It is explained very well and has helped so many of us with so many issues. My life has changed – actually I’ve been given back my life – after 25 years of hot flashes, too much weight that I couldn’t lose, drastic mood swings and more issues. Progesterone in physiological amounts balances the overload of xenoestrogens that we get from food, cleaning products, personal care products, pesticides, and so much more. My body is in much greater balance, I am not a nasty woman and I enjoy getting up in the morning. Estrogen needs to be balanced by the often-overlooked hormone, progesterone. I thanks Dr. Lee for all his information and I wish more women knew about this.

  13. Maureen says:

    Many very young girls who have painful periods take birth control pills to ease their symptoms. They continue the pill once they become sexually active, finish their education, and begin their careers, stopping at a later date for pregnancy.

    Later, many of these young women find it difficult to conceive and turn to hormone therapies to increase the number of their eggs that will mature each month, to be harvested for IVF. This can continue for a number of cycles and years.

    Some women who find their subsequent pregnancy threatened, are prescribed progestin suppositories in the first trimester.

    Many women return to the pill between births. Then as they enter perimenopause they endure hot flashes, hair loss, sleep disturbances, etc., and they turn to HRT.
    Sorry this is long-winded, but my point is that a typical lifetime exposure to prescribed estrogen and progestin could be enormous.

    This exposure could explain the disparity of cancer incidences between white women and African-American women. White women get breast cancer at much higher rates than black women, but the severity and morbidity of the disease is higher among black women.

    Can you guide me to research on lifetime exposure and breast cancer?
    Thanks,
    Maureen

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  15. gigica says:

    Nice article man. Keep up the good work.

  16. Yer Furman says:

    For the most part, I agree with the Doctor’s comments however, I do not trust the “two year window” due to the fact that no long-term study exists showing that a woman taking HRT in her early to mid-50’s wouldn’t run an elevated risk of developing breast cancer or some other type of endometrial cancer ten or fifteen years later. Proponents of HRT are likely looking at actuarial tables as a big part of their analysis and realize that someone taking HRT for two years (in her early to mid-50) might die of unrelated or “natural” causes before they actually had a chance to die of breast cancer. Sorry, but no thanks. The same applies to bioidenticals; there just is not enough evidence as to safety. On the other hand, I have had good luck with concentrated flax hull lignans which provide moderate menopause symptom relief and helps to prevent aberrant cell regeneration similar to Tamoxifen, but without the negative side-effects.

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