NIH Study regarding HRT and BReast cancer

[Anonymous]

[quote=Anonymous][quote=Anonymous][quote=Anonymous]Progestin and progesterone is not the same and the latest findings are that micronized progesterone seems much safer—but more data is needed.[/quote]

Here’s the citation:
Conclusion: Although menopausal HT use appears to be associated with an overall increased risk of breast cancer, this risk appears predominantly mediated through formulations containing synthetic progestins. When prescribing menopausal HT, micronized progesterone may be the safer progestogen to be used.

https://pubmed.ncbi.nlm.nih.gov/35675607/[/quote]

I posted the above, reposting for the “scientist.” (I’m also a trained researcher but not related to medicine.)

To the person/s claiming there aren’t different types of progestins/progesterone, that is false. There are, and micronized progesterone, which is identical to what the body produces, is taught not to raise breast cancer risk. Studies are ongoing but the early indications are in that direction.

Someone else posted correctly that previous studies, which relied on synthetic progestins raised bc risk from 4.1% to 4.5%; however, even in those studies, overall mortality was lower in the treatment arm (group).

The best thing really is to pick a provider from Menopause.org and ask that person all the qualifications you have. So many posters on this thread are authoritatively making s#!t up.[/quote]

Good try. These were Swedish women so very homogenous unlike US populations. The study results are not delivered by age or by onset of menopause and so people 50-75 were lumped together. That's a problem b/c the NIH study that started this whole mess was based on people over 62 where a tiny effect was found. That same effect was not found in the younger cohort.

It's semantics that there's only one HRT. I would argue that two hormones versus one is a different type of HRT. I would also argue the same about the different delivery systems. Why so hostile?

[Anonymous]

Anonymous wrote:

Anonymous wrote:I thought estrogen only was riskier than estrogen and progesterone and am skeptical that a cardiologist would be the most critical physician of HRT in a trio of gyn, cardiologist, and primary. Not credible at all, PP.

You think PP came here to lie about what her doctors said? OK.

I do. I know how these threads go. Bless your heart.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I thought estrogen only was riskier than estrogen and progesterone and am skeptical that a cardiologist would be the most critical physician of HRT in a trio of gyn, cardiologist, and primary. Not credible at all, PP.

You think PP came here to lie about what her doctors said? OK.

I do. I know how these threads go. Bless your heart.

Estrogen only actually lowers bc risk but increases uterine cancers risk which is why progesterone is added, which raises bc risk but seemingly only with some forms of progesterone.

[Anonymous]

I’m one of those women who started using online HRT (Inner Balance/Oestra) after my PCP seemingly had no answers for my peri symptoms. At her suggestion, I went back on birth control for a couple years, which helped until it didn’t. Then she suggested an SSRI (lexapro, which had more side effects than benefits). Meanwhile, my insomnia and mood and energy issues, not to mention debilitating cramps, were growing increasingly intolerable.

HRT hasn’t been a cure-all (I still take gummies for sleep), but it’s made a huge difference in mood, energy and in eliminating cramps. I even feel like my “menopause face” is better, not as droopy.

Maybe there IS a risk, but I’m not sure what most doctors expect women to do when they can’t or won’t help.

[Anonymous]

I was just diagnosed with breast cancer. No family history of it. I'm 49 and was put on HRT 3 years ago to manage perimenopause symptoms.

Note, my breast cancer is early stage, and is treatable, so I will hopefully not be counted in any "mortality" numbers, but still it's so much to go through (surgery, radiation and guess what?! Bc my cancer is positive for hormone receptors, I have to take basically anti-estrogen meds for the next several years to make sure it doesn't come back). Anecdotal, obviously, but HRT has definitely not been worth this.

I think the guidance will eventually shake out at not starting HRT until after full menopause.

Also, for the many women who have dense breast tissue (I do), that can hide the earliest detection of a breast tumor. Density naturally does go down in full menopause so that's another factor to consider if you're perimenopausal and taking HRT, that any cancer might be more difficult to spot. Make sure you're vigilant about screenings.

[Anonymous]

Anonymous wrote:I was just diagnosed with breast cancer. No family history of it. I'm 49 and was put on HRT 3 years ago to manage perimenopause symptoms.

Note, my breast cancer is early stage, and is treatable, so I will hopefully not be counted in any "mortality" numbers, but still it's so much to go through (surgery, radiation and guess what?! Bc my cancer is positive for hormone receptors, I have to take basically anti-estrogen meds for the next several years to make sure it doesn't come back). Anecdotal, obviously, but HRT has definitely not been worth this.

I think the guidance will eventually shake out at not starting HRT until after full menopause.

Also, for the many women who have dense breast tissue (I do), that can hide the earliest detection of a breast tumor. Density naturally does go down in full menopause so that's another factor to consider if you're perimenopausal and taking HRT, that any cancer might be more difficult to spot. Make sure you're vigilant about screenings.

I’m sorry to hear about your diagnosis. I’m glad they caught it early and I wish you the best.

I guess I’m confused because aren’t the HRT dosages really low? And aren’t women on a higher doses of estrogen earlier in life when most of us are on birth control? And don’t estrogen rate skyrocket when we are pregnant and yet we don’t tend to see a correlation with women getting diagnosed with breast cancer after pregnancy.

It seems like it’s just too simple to say estrogen for hormone replacement therapy is causing cancer. The fact of the matter is breast cancer is rising in young women and yet very few young women are on replacement therapy, especially since the big study in the early 2000s hormone replacement therapy rates have plunged so there’s clearly more to the story on why younger women are getting breast cancer and it’s not just estrogen or hormone replacement therapy.

I really fear we’re missing the forest through the trees when people just lump these early rates of cancer as HRT when most women being diagnosed early, have not started HRT yet.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Why is this a surprise? HRT and cancer were linked even when I was in college like 30 years ago!
Why so many people recommend HRT is beyond me!

+1

Keep up. That was a scientific mistake that has been corrected with new research. Science does not stop once one study finds one tiny effect.

What? It’s still thought that HRT raises breast cancer risk. The question is whether that is worth it to you.

https://www.breastcancer.org/risk/risk-factors/using-hormone-replacement-therapy

[Anonymous]

Anonymous wrote:

Anonymous wrote:I was just diagnosed with breast cancer. No family history of it. I'm 49 and was put on HRT 3 years ago to manage perimenopause symptoms.

Note, my breast cancer is early stage, and is treatable, so I will hopefully not be counted in any "mortality" numbers, but still it's so much to go through (surgery, radiation and guess what?! Bc my cancer is positive for hormone receptors, I have to take basically anti-estrogen meds for the next several years to make sure it doesn't come back). Anecdotal, obviously, but HRT has definitely not been worth this.

I think the guidance will eventually shake out at not starting HRT until after full menopause.

Also, for the many women who have dense breast tissue (I do), that can hide the earliest detection of a breast tumor. Density naturally does go down in full menopause so that's another factor to consider if you're perimenopausal and taking HRT, that any cancer might be more difficult to spot. Make sure you're vigilant about screenings.

I’m sorry to hear about your diagnosis. I’m glad they caught it early and I wish you the best.

I guess I’m confused because aren’t the HRT dosages really low? And aren’t women on a higher doses of estrogen earlier in life when most of us are on birth control? And don’t estrogen rate skyrocket when we are pregnant and yet we don’t tend to see a correlation with women getting diagnosed with breast cancer after pregnancy.

It seems like it’s just too simple to say estrogen for hormone replacement therapy is causing cancer. The fact of the matter is breast cancer is rising in young women and yet very few young women are on replacement therapy, especially since the big study in the early 2000s hormone replacement therapy rates have plunged so there’s clearly more to the story on why younger women are getting breast cancer and it’s not just estrogen or hormone replacement therapy.

I really fear we’re missing the forest through the trees when people just lump these early rates of cancer as HRT when most women being diagnosed early, have not started HRT yet.

Hmm almost as if you might want to look at the people who systematically study the questions you raise? Come on.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I was just diagnosed with breast cancer. No family history of it. I'm 49 and was put on HRT 3 years ago to manage perimenopause symptoms.

Note, my breast cancer is early stage, and is treatable, so I will hopefully not be counted in any "mortality" numbers, but still it's so much to go through (surgery, radiation and guess what?! Bc my cancer is positive for hormone receptors, I have to take basically anti-estrogen meds for the next several years to make sure it doesn't come back). Anecdotal, obviously, but HRT has definitely not been worth this.

I think the guidance will eventually shake out at not starting HRT until after full menopause.

Also, for the many women who have dense breast tissue (I do), that can hide the earliest detection of a breast tumor. Density naturally does go down in full menopause so that's another factor to consider if you're perimenopausal and taking HRT, that any cancer might be more difficult to spot. Make sure you're vigilant about screenings.

I’m sorry to hear about your diagnosis. I’m glad they caught it early and I wish you the best.

I guess I’m confused because aren’t the HRT dosages really low? And aren’t women on a higher doses of estrogen earlier in life when most of us are on birth control? And don’t estrogen rate skyrocket when we are pregnant and yet we don’t tend to see a correlation with women getting diagnosed with breast cancer after pregnancy.

It seems like it’s just too simple to say estrogen for hormone replacement therapy is causing cancer. The fact of the matter is breast cancer is rising in young women and yet very few young women are on replacement therapy, especially since the big study in the early 2000s hormone replacement therapy rates have plunged so there’s clearly more to the story on why younger women are getting breast cancer and it’s not just estrogen or hormone replacement therapy.

I really fear we’re missing the forest through the trees when people just lump these early rates of cancer as HRT when most women being diagnosed early, have not started HRT yet.

Hmm almost as if you might want to look at the people who systematically study the questions you raise? Come on.

I’m not the PP you’re addressing, just FYI.

You have such a distinctive writing style and I always get sad when I read your combative-dismissive posts.

Here you go:
https://www.breastcancer.org/risk/risk-factors/using-hormone-replacement-therapy

“In women with no history of breast cancer, taking systemic estrogen-only HRT is not linked to a higher risk of breast cancer, according to the Women’s Health Initiative studies and other research. In certain groups of women, such as those who have no family history of breast cancer or benign breast disease, systemic estrogen-only HRT actually appears to lower the risk of breast cancer. “

[Anonymous]

Anonymous wrote:

Anonymous wrote:This is a new study, not the old discredited one?

Is there a scientist on here that can explain what it means when it’s talking about the different kinds of HrR? It sounds like the risk is only elevated with one kind and is actually decreased with another kind?

There aren't two "kinds" of HRT, but rather whether you need to take progesterone along with the estrogen (aka "combo"). Unless you have had a hysterectomy, you do need need the combo, because estrogen-only will mess with your uterine lining.

Studies seem fairly definitive that there is no downside to estrogen-only treatment, but the jury is out on the risk of the combo treatment. Unfortunately without actual science, those of us who believe we could benefit from HRT are left to decide on our own whether it's worth the risk. Different doctors will tell you different things. It's all quite maddening.

only in the context of breast cancer. studies are very clear that unopposed estrogen leads to an increase of risk in uterine cancer, so pick your poison i guess.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I was just diagnosed with breast cancer. No family history of it. I'm 49 and was put on HRT 3 years ago to manage perimenopause symptoms.

Note, my breast cancer is early stage, and is treatable, so I will hopefully not be counted in any "mortality" numbers, but still it's so much to go through (surgery, radiation and guess what?! Bc my cancer is positive for hormone receptors, I have to take basically anti-estrogen meds for the next several years to make sure it doesn't come back). Anecdotal, obviously, but HRT has definitely not been worth this.

I think the guidance will eventually shake out at not starting HRT until after full menopause.

Also, for the many women who have dense breast tissue (I do), that can hide the earliest detection of a breast tumor. Density naturally does go down in full menopause so that's another factor to consider if you're perimenopausal and taking HRT, that any cancer might be more difficult to spot. Make sure you're vigilant about screenings.

I’m sorry to hear about your diagnosis. I’m glad they caught it early and I wish you the best.

I guess I’m confused because aren’t the HRT dosages really low? And aren’t women on a higher doses of estrogen earlier in life when most of us are on birth control? And don’t estrogen rate skyrocket when we are pregnant and yet we don’t tend to see a correlation with women getting diagnosed with breast cancer after pregnancy.

It seems like it’s just too simple to say estrogen for hormone replacement therapy is causing cancer. The fact of the matter is breast cancer is rising in young women and yet very few young women are on replacement therapy, especially since the big study in the early 2000s hormone replacement therapy rates have plunged so there’s clearly more to the story on why younger women are getting breast cancer and it’s not just estrogen or hormone replacement therapy.

I really fear we’re missing the forest through the trees when people just lump these early rates of cancer as HRT when most women being diagnosed early, have not started HRT yet.

Hmm almost as if you might want to look at the people who systematically study the questions you raise? Come on.

I’m not the PP you’re addressing, just FYI.

You have such a distinctive writing style and I always get sad when I read your combative-dismissive posts.

Here you go:
https://www.breastcancer.org/risk/risk-factors/using-hormone-replacement-therapy

“In women with no history of breast cancer, taking systemic estrogen-only HRT is not linked to a higher risk of breast cancer, according to the Women’s Health Initiative studies and other research. In certain groups of women, such as those who have no family history of breast cancer or benign breast disease, systemic estrogen-only HRT actually appears to lower the risk of breast cancer. “

DP. You’re a good person. I don’t feel “sad” over that woman’s contributions. She is nasty and dishonest on these threads. Thank you for including good cites in your compassionate reply.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I was just diagnosed with breast cancer. No family history of it. I'm 49 and was put on HRT 3 years ago to manage perimenopause symptoms.

Note, my breast cancer is early stage, and is treatable, so I will hopefully not be counted in any "mortality" numbers, but still it's so much to go through (surgery, radiation and guess what?! Bc my cancer is positive for hormone receptors, I have to take basically anti-estrogen meds for the next several years to make sure it doesn't come back). Anecdotal, obviously, but HRT has definitely not been worth this.

I think the guidance will eventually shake out at not starting HRT until after full menopause.

Also, for the many women who have dense breast tissue (I do), that can hide the earliest detection of a breast tumor. Density naturally does go down in full menopause so that's another factor to consider if you're perimenopausal and taking HRT, that any cancer might be more difficult to spot. Make sure you're vigilant about screenings.

I’m sorry to hear about your diagnosis. I’m glad they caught it early and I wish you the best.

I guess I’m confused because aren’t the HRT dosages really low? And aren’t women on a higher doses of estrogen earlier in life when most of us are on birth control? And don’t estrogen rate skyrocket when we are pregnant and yet we don’t tend to see a correlation with women getting diagnosed with breast cancer after pregnancy.

It seems like it’s just too simple to say estrogen for hormone replacement therapy is causing cancer. The fact of the matter is breast cancer is rising in young women and yet very few young women are on replacement therapy, especially since the big study in the early 2000s hormone replacement therapy rates have plunged so there’s clearly more to the story on why younger women are getting breast cancer and it’s not just estrogen or hormone replacement therapy.

I really fear we’re missing the forest through the trees when people just lump these early rates of cancer as HRT when most women being diagnosed early, have not started HRT yet.

Breast cancer rates absolutely do go up in the immediate period after pregnancy. It’s not “skyrocketing” rates (cancer statistics are rarely like that) but a clear statistically significant amount. Any internet search will confirm this.

I think after this wave of it being trendy to take hrt even for very little need (I have a friend with very minor menopause symptoms who was surprised that she was just handed a prescription for HRT by her gyn - she didn’t ask for it and didn’t really want it) there are going to be others like the 49 year old pp above. And the sad/ironic thing is that having to take estrogen blockers for hormone positive breast cancer makes all of those menopause symptoms even worse.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I was just diagnosed with breast cancer. No family history of it. I'm 49 and was put on HRT 3 years ago to manage perimenopause symptoms.

Note, my breast cancer is early stage, and is treatable, so I will hopefully not be counted in any "mortality" numbers, but still it's so much to go through (surgery, radiation and guess what?! Bc my cancer is positive for hormone receptors, I have to take basically anti-estrogen meds for the next several years to make sure it doesn't come back). Anecdotal, obviously, but HRT has definitely not been worth this.

I think the guidance will eventually shake out at not starting HRT until after full menopause.

Also, for the many women who have dense breast tissue (I do), that can hide the earliest detection of a breast tumor. Density naturally does go down in full menopause so that's another factor to consider if you're perimenopausal and taking HRT, that any cancer might be more difficult to spot. Make sure you're vigilant about screenings.

I’m sorry to hear about your diagnosis. I’m glad they caught it early and I wish you the best.

I guess I’m confused because aren’t the HRT dosages really low? And aren’t women on a higher doses of estrogen earlier in life when most of us are on birth control? And don’t estrogen rate skyrocket when we are pregnant and yet we don’t tend to see a correlation with women getting diagnosed with breast cancer after pregnancy.

It seems like it’s just too simple to say estrogen for hormone replacement therapy is causing cancer. The fact of the matter is breast cancer is rising in young women and yet very few young women are on replacement therapy, especially since the big study in the early 2000s hormone replacement therapy rates have plunged so there’s clearly more to the story on why younger women are getting breast cancer and it’s not just estrogen or hormone replacement therapy.

I really fear we’re missing the forest through the trees when people just lump these early rates of cancer as HRT when most women being diagnosed early, have not started HRT yet.

Breast cancer rates absolutely do go up in the immediate period after pregnancy. It’s not “skyrocketing” rates (cancer statistics are rarely like that) but a clear statistically significant amount. Any internet search will confirm this.

I think after this wave of it being trendy to take hrt even for very little need (I have a friend with very minor menopause symptoms who was surprised that she was just handed a prescription for HRT by her gyn - she didn’t ask for it and didn’t really want it) there are going to be others like the 49 year old pp above. And the sad/ironic thing is that having to take estrogen blockers for hormone positive breast cancer makes all of those menopause symptoms even worse.

It looks like about one out of 3000 women get diagnosed with breast cancer shortly after pregnancy. This number includes women who are predisposed genetically for breast cancer so we don’t know the risk of the general population other than that it’s very small considering the average woman has a one and 12 risk of breast cancer.

We could argue about this all day, but I think we’re doing women a real disservice when we say the risk of breast cancer is due to hormone replacement therapy- less than 5% of women take hormone replacement therapy. Yet cancer rates have been rising - clearly there are other things we need to focus on.

I feel really bad for any women on this thread who smugly thinks they won’t get breast cancer because they’re not doing HRT. Many of them will be in for a rude awakening.

We can argue and fight amongst ourselves, or we can demand more research, better screening modalities, and more answers. Or we can just shame women for trying to feel better during perimenopause and menopause.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:This is a new study, not the old discredited one?

Is there a scientist on here that can explain what it means when it’s talking about the different kinds of HrR? It sounds like the risk is only elevated with one kind and is actually decreased with another kind?

There aren't two "kinds" of HRT, but rather whether you need to take progesterone along with the estrogen (aka "combo"). Unless you have had a hysterectomy, you do need need the combo, because estrogen-only will mess with your uterine lining.

Studies seem fairly definitive that there is no downside to estrogen-only treatment, but the jury is out on the risk of the combo treatment. Unfortunately without actual science, those of us who believe we could benefit from HRT are left to decide on our own whether it's worth the risk. Different doctors will tell you different things. It's all quite maddening.

only in the context of breast cancer. studies are very clear that unopposed estrogen leads to an increase of risk in uterine cancer, so pick your poison i guess.

Yeah, I feel like citing the estrogen-only studies is disingenuous, because no doctor will prescribe estrogen only for a woman who still has a uterus, due to the risk of uterine cancer. I'm on HRT, so I've decided (for the moment) that the benefits outweigh the risks, but I think this is all worth more study to help women weigh the pros and cons, and to figure out better monitoring. For instance, I don't think there's any real scientific guidance on amounts -- my gyn is pretty knowledgeable but seemed to be basically guessing at the dosage to give me. Because there was almost no research for decades, there is a lot we still don't know.

[Anonymous]

[quote=Anonymous][quote=Anonymous]Progestin and progesterone is not the same and the latest findings are that micronized progesterone seems much safer—but more data is needed.[/quote]

Here’s the citation:
Conclusion: Although menopausal HT use appears to be associated with an overall increased risk of breast cancer, this risk appears predominantly mediated through formulations containing synthetic progestins. When prescribing menopausal HT, micronized progesterone may be the safer progestogen to be used.

https://pubmed.ncbi.nlm.nih.gov/35675607/[/quote]

+1,000 we’ve known for awhile progestins have issues and are not the same as progesterone (in the US, prescribed as brand name Prometrium)(and that taking via skin/vagina avoids liver metabolizing them into other metabolites/forms). Yet progestins are still what we hock to younger women as patentable and expensive BCPs. And apparently the new drugs to treat post partum depression aren’t normal estradiol and progesterone and are crazy chemical synthetic versions of the real hormones. But OP, keep railing against the only form of bioidentical hormones, hrt, bc that helps women… lemme guess, you’ve never taken hrt.