Don't Be Fooled By New Study On Hormone Replacement Therapy

"Menopausal Hormone Therapy and Breast Cancer Link Confirmed," the headline reads.

On August 29, the British medical journal The Lancet published the results of a large meta-analysis titled, "Type and timing of menopausal hormone therapy and breast cancer risk: individual participant meta-analysis of the worldwide epidemiological evidence".  The researchers combined 58 studies to compare the current and past use of "menopausal hormone therapy" [MHT] among 100,000 women with breast cancer to 420,000 women without breast cancer.

They concluded that, except for vaginal "estrogen" users, all other users of MHT have an increased risk of breast cancer.  This is worse for those using "progestagens" in combination with "estrogens" than those using "estrogens" alone.  And in both cases, the risks increased the longer the drugs were used.

Like the ill-fated Women's Health Initiative of 2002, this meta-analysis makes for a great scare tactic to keep menopausal women from pursuing or continuing hormone replacement.  But the devil is always in the details.

First, I noted that, in the breakdown of the different formulations of "estrogens" studied, there was no mention of estradiol pellets.  This is a big deal because they are claiming that ALL types of hormone replacement increase breast cancer.  You can't make that claim if you don't study all types!  And you can't lump estradiol in with artificial or horse estrogens because these other forms are never found naturally in the human body.  And you can't lump pellets in with pills, patches, creams, troches, or shots because pellets bypass the liver on the way to the bloodstream and provide VERY small, steady levels of estradiol over a period of months.

Second, the breakdown listed 4 different progestogens, which we might for simplicity call "progesterone-like drugs."  The problem is that none of the studies actually studied human progesterone.  Hmmm.  I can't remember the last time I prescribed a progestagen for hormone replacement.  Oh, wait:  Never.

Ironically, this grand study of menopausal hormone replacement left out the most critical hormone for menopause:  Testosterone.  Numerous studies have demonstrated that in both men AND women, testosterone reduces death from breast cancer and all other causes of death.

The bottom line is, if you are one of our many happy patients receiving pellet therapy, rest assured that this study does not warrant any change in your treatment.  If anything, it reinforces that what you are doing is right for you. 

Even those of you who are not our patients and have been prescribed artificial hormones don't need to panic:  The risk is not as great as the headline would suggest.  Taking one of those "progesterone-like drugs" along with one of the estrogenic drugs only increased breast cancer by 1 out of every 50 women who used them for 5 years.  That's not a huge number. 

But if you switch to bioidentical testosterone pellets, studies show that your risk of breast cancer drops to significantly less than women who choose to let nature run its course.

I'm Dr. Ray Andrew, and this has been the Medical Minute.  Thanks for listening.

Ray Andrew, MD

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