New report about HRT risks on BBC website

[Egghead68]

Menopausal hormone therapy risks 'bigger and last longer' than thought www.bbc.co.uk/news/health-49508671

@NotWavingButMNing Really sorry to hear about your BC. I am not sure where the figure of 1:20 cases due to HRT? That's 5% anyway.

The stas show that for women not using HRT there are 6 cases per 100 and for women using it there are 7.4 cases per 100.

The British Menopause Society has made this useful statement on the report (a meta analysis of a number of old studies) on its website:
thebms.org.uk/2019/08/bms-response-to-lancet-paper-on-the-link-between-different-forms-of-hrt-and-breast-cancer-incidence/

For those asking about types of HRT and different risk profiles, the study shows that dydrogesterone (Femoston) has a lower bc risk. The number of women taking micronised progesterone (Utrogestan) in the study is too small to be able to make any conclusions (according to the BMS). However from what we know of other studies, Utrogestan like dydrogesterone is more breast friendly (though still seems to come with a small risk).

I should add that I'm in no way an expert on this, but I've done a lot of research (for my own benefit, as I take HRT) and I read the entire Lancet study.

@Firstgirlonmars There are other papers out there on the use of micronised progesterone, namely the French EN3 studies. www.ncbi.nlm.nih.gov/pmc/articles/PMC3815310/

@JinglingHellsBells Thanks - yes, I know that one. I've become a bit of an HRT research nerd since I had to start taking it :) What's also interesting about the BMS letter that I linked to is that it points out there is no evidence of a higher death rate for HRT users (from bc or any other cause).

Unfortunately a percentage of women go on HRT without giving their body the time to balance.
Most women will come through the other side of the menopause feeling a great deal better. Obviously not the ones posting on here because we are the minority.
Yes the menopause is hell but there is light at the end of the tunnel for most people (again not those that are statistically unlucky).
I felt like death for years (over ten) but three years since my last period I feel better than I have ever felt in my life.
I thought I was going to be sick, ill, depressed, anxious and insane for life. I thought I was never going to feel health and happiness again.
I really urge all those women who feel like giving up and going on HRT to have faith that you will most probably come through the other side feeling okay...maybe even better than before.

I really don’t know if there is any benefit from researchers like this. We are told so different things and we finally doubt about everything. For me hrt is the only solution as I am only 43 and face an early menopause. I was almost suicidal during my peri and with hrt I can go on my life, it is the only way for me.

Try listening to the R4 WATO interviews at 1300 today.
The experts trashed the report because it wasn't new research, just a pulling together of 30 odd years of research epidemiology which ignored the much better HRT, ignored the heart and bone benefits and any predispositions because of alcohol, obesity, genetics.

I do so wish more scientists and mathematicians would go into reporting. This sort of "report" needs to blasted into space by people who understand where it comes from and not have journalists who have no idea of medical research accepting headlines from papers they don't read or can't understand and frightening the life out of people.

@whatpasswordtochoose The thing is, you have been lucky. Symptoms can last for 15-10 years for some women and even for life. If the flushes and mood swings etc abate after 3 years, there is still the risk of loss of bone density, joint issues, pelvic floor issues and heart disease. The real question is how long should women put up with terrible quality of life and risk long term serious diseases, when HRT might prevent this?

@crosstalk It's Prof Val Beral who is always involved in these reports and she is very anti HRT. I've read interviews with her and listened to her on radio and she never answers certain questions, or talks about the pros of HRT for some women. Her own study the Million Women one was funded by Cancer Research so what does that tell you? It was blasted into space by other scientists as being unreliable and flawed.

Did you just see Mariella Frostrup on channel 4 news? She did a great piece balancing the increase in risk reported today with the increase in risk from obesity & alcohol. AND then she talked about the lack of investment in research on women's health issues including that it was only in 1993 that legislation was brought in to include women and minorities in medical research.

She was ace!

Well done Mariella!

There are so many women journalists of a certain age around now. I wish more of them would get on the case. It is hard enough to get good information on HRT without sensationalist headlines confusing everyone.

Women need proper information and proper risk evaluation.

The people who wrote the Lancet report are all statisticians and scientists. They know a bit about math. The article is free access. It's good quality research by very top notch people. The supplemental tables (all the different subgroupings) are online. Some of the subgrouping looked at relatively more recent data (the prospective studies had median yr of diagnosis = 2005).

I got misquoted in some press coverage recently on a study we published; I am going to be more careful in future not to give journos any room for such terrible misquoting. It's a total pain when you carefully prepare a press release & journos drop all nuance in what you said.

Today's main WATO commentators were Liz Earl (cosmetic person), & Frostrup (Tv presenter). So they are experts on cosmetics & media presentation. The actual academic (Lumsden) did not trash the study. Lumsden said good things about putting the study findings in perspective.

I finally found an RCT on quality of life after HRT or placebo (woohoo!). It's supportive of HRT for a few definite but modest advantages in Qual of Life outcomes. And found no HRT advantage for 6 outcomes. There should indeed be more RCTs on HRT.

Prof Michael Baum who has possibly done more for women and breast cancer as an oncologist and BC expert has absolutely slated this research. You can find his statement about it on Twitter and also on Dr Louise Newson's Website and on twitter under his own @

................................................................................................................

Following a high profile article published in the Lancet on 30th August 2019, Professor Michael Baum wrote the following, plain English, response:

Professor Michael Baum’s response to the Lancet’s publication of a report on HRT
Friday 30th August 2019

I think the press release put out by the Lancet is irresponsible and will undoubtedly lead to a drop in the use of HRT/ERT plunging thousands of women into a life of misery and for all we know shorten the lives of millions around the world. Remember there are more important threats to women’s lives than breast cancer, which is now only 7th in the league whilst those higher up the league might increase as a result of the withdrawal of oestrogen replacement therapy. “Statistical significance” does not always translate into “clinical significance”.

Two principles in the practice of medicine – improve length of life (LOL) and quality of life (QOL).
In the modern era paternalism of the profession has been replaced by the principle of partnership whereby patients are helped to make informed decisions.
The paper in today’s Lancet and its press release is alarmist and will frighten off thousands of women from taking HRT and is of no help for women in making informed choices.
This paper is extremely difficult to understand even by an expert like me, and I would need many hours to ingest it all.
The publication contains data from about 100,000 women taking part in clinical trials of complex design going back more than 20 years and provides a summation of both published and unpublished data using complex methodology.
The report is framed to prove relative risks (RRs) of the INCIDENCE of breast cancer. For the lay women to understand this I’ve found a description of absolute values below.
The simplest way I can distil the results for the lay reader is as follows:
If we consider a woman aged 50 who takes combined HRT for 5 years who is followed up for 20 years, the incidence of breast cancer goes up from 6.3% to 8.3%, an additional 2%.
If we consider a woman aged 50 who takes oestrogen alone (ERT) for 5 years and is followed up for 20 years the incidence goes up from 6.3% to 6.8%, an additional 0.5%.
NB we are only given numbers for INCIDENCE not breast cancer mortality or all-cause mortality.
Breast cancer mortality might be unaffected because there is an imbalance in the incidence of oestrogen receptor positivity (ER+) favouring those women on HRT/ERT.
All cause mortality might favour those on HRT/ERT because of reduction in heart disease, stroke, osteoporosis, dementia and suicide.
The benefits of HRT/ERT in improving quality of life are beyond questions.
Finally, the whole edifice might crumble if we correct the data for the numbers of “over diagnosed” cases from XS use of mammograms amongst women on HRT/ERT who are frightened of developing breast cancer. It thus becomes a self-fulfilling prophecy.
Professor Michael Baum
30th August 2019

whatpasswordtochoose The thing is, you have been lucky
I'm not sure. Like you whatoassword, I am soooo much better now that I'm fully into the menopause. Sleep is still elusive but otherwise, I feel better now than I have in 10 years and it gets better months on months. My mum was just the same and talking to other women who've been though it it's not so uncommon.

Some women go through peri not even knowing and struggle once fully into the menopause, but others go through hell during the peri stage and the memo comes with a new breath of life.

Did the research adjust to account for those that were obese, drank alcohol and didn't breast feed?
I am often a little wary of research studies. Not to say there isn't anything in the overall point if there being risks to HRT but there are also risks to not taking it for some.

A colleague was telling me recently about how the fastest cars are red. This is because most racing cars are red. The point he was making is that the data could be interpreted as 'red paint makes cars go faster'. Imagine the headlines.

When I had a baby late in life (41) my aunt told me that I would not experience menopause symptoms. She had had a baby at 46. Not sure if that was just her experience or an old wives tale but I must say my symptoms are very light other than joint pain that I have always had. I do wonder if more research could be done about menopause and how to reduce symptoms and also what things make it worse. Do we know what impact, if any, chemical contraception has on menopause

People who drive fast like red?

I have been on COC most of my reproductive life, and when I came off, all I could find out was that it had no effect. It did not shield me from meno symptoms, especially night sweats which it made worse, in the last 3 years, and I think my ovaries tried to ovulate everything all at once when I came off.

I think it is because most formula 1 cars are painted red so technically it is correct to say the fastest cars manufactured are red. It would however be wrong to conclude that red paint makes cars faster. It made me chuckle when he told me. I think he was trying to illustrate that coexisting factors do not necessarily point to a cause. So for example could you find that women who take HRT are also more likely to do X and that it could be X that increases the chances of developing BC and not the HRT? I have no idea but I think it is wise to approach research reports with an analytical brain.

I've just obtained some patches from Spain. I'm on Evorel 50 in the UK but they're called Evopad 50 there. Also made by Janssen. I thought this info. might help others.
My sister who is also on the same patches and just happens to be a doctor reckons that the Nhs want to stop the use of patches due to the increased cost to the Nhs. This research will sadly also be used by gps as an excuse not to prescribe.

So for example could you find that women who take HRT are also more likely to do X and that it could be X that increases the chances of developing BC and not the HRT?

Proper double blind trials would weight the results so that obesity, alcohol and exercise were taken into account. The problem with the report in the Lancet is it combined stats from lots of random studies including those like the WHI and MW which were flawed.

The reverse of what you assume above is the case. HRT is taken by women who are well educated and who tend to look after their health. They also tend to have more mammograms .

In The Times today Dr Mark Porter comments on use of HRT and says most female gynaecologists use it as do male drs wives.

I take HRT for ivf and have done on and off for a nearly 8 years. This report scares me although women have been informed of risks and it does specify in the instructions for use leafet in the box but it still worrys me. Im only 34 and dont want to be worrrying about this for years

This research will sadly also be used by gps as an excuse not to prescribe Unlikely. Most of the medical profession have dismissed this report. it says nothing new other than the risk of cancer may linger longer.

The risk is small- non HRT use is 6% cancer risk, HRT risk is 7.4% over 20 yrs. So that is between 1 and 2 extra cases per 100 women. And the report didn't cover different types of HRT they just headlined the 'worst case scenario' using the oldest types (Pills and synthetic progestogens.)

Funny how people still drive when 10 people a day die on the roads.
No one says we should stop driving.

In The Times today Dr Mark Porter comments on use of HRT and says most female gynaecologists use it as do male drs wives
Surely the decision of whether to take hrt is mostly based on whether symptoms are controlled or not whatever your IQ and your profession. I find it hard to believe that most gynae had such symptoms that they all needed hrt. Many women go through it fine and others do without it because hrt doesn't (as was the case for me, it actually made me feel worse).

This account seems very biased and pro hrt.

It feels balanced to me and not 'pro HRT' as such but I agree the menopause is not the same for everyone. My sister welcomed it as her PMT was very very severe. I bizarrely have less brain fog than when I was regularly menstruating. But I do know some women who really struggle and I met 2 women recently who had such positive experience with HRT they were a very persuasive case study to take it. I know another couple of women who have found HRT a bit meh....