Warned about cancer risks when prescribed HRT today

[FelicityFlowers]

My GP prescribed me HRT and progesterone today, via a telephone call. We were talking it all through and she said 'you are aware of the increased risk of breast and ovarian cancer aren't you?'

I said my understanding was that there was no increased risk of either cancer and she said that wasn't the case.

So.. who's right? I didn't particularly want to get into a debate as I'm not a doctor but I was a bit

Basically, HRT increases breast cancer risk a teeny tiny bit. The older you are, the less teeny the increase.

Thanks FelicityFlowers. Pill in my 20s and vaccinations etc. I waited til I was 55 for help. My symptoms I hope will be helped. Maybe I will calm down!

@DinkyDaisy I feel similar to you in that it's such a new thing for me, and I'm the sort of person who needs to fully understand the ins and outs.

Do watch the Davina documentary if you haven't already

HRT has been the BeST thing I have done to save my mental health and well-being. I intend to keep taking it for as long as I live. I am aware of the very small increase in risks for certain cancers but I don’t shove crap food down my throat and try and take exercise and don’t smoke so hopefully that will balance out my tiny increase in cancer risk.

www.breastcancer.org/risk/factors/hrt

www.cancerresearchuk.org/about-cancer/causes-of-cancer/hormones-and-cancer/does-hormone-replacement-therapy-increase-cancer-risk

www.nhs.uk/conditions/hormone-replacement-therapy-hrt/risks/

assets.publishing.service.gov.uk/media/5d680409e5274a1711fbe65a/Table1.pdf

My understanding is it's the progesterone element of combined HRT that may increase the risk of female cancers. However, there are other lifestyle factors that also increase the risk. My GP prescribed femoston 2/10 for a 3 month trial as a kind of starting point to see how I felt. Then we can look at tailoring a regime. She advised to take as little progesterone as possible but enough to control womb thickness. And body identical or as close as. Some of the synthetic progesterone are better than others.

I'm 49, my mum had breast cancer when she was 48. But that was in the mid 1990's. I really tried to avoid HRT but I was feeling so very unwell for so long that life was absolutely miserable. I seriously considered giving up the job I love as I couldn't see myself being able to continue working I felt so ill. 3 weeks into my first cycle of HRT the dreadful bone pain, joint pain and body aches have gone. Night sweats and hot flushes are lessening, I feel much more balanced and don't feel that I'm becoming unhinged. I've had a rough week work/family wise. A month ago I would have struggled to get through physically and mentally. I'm tired today but nothing major under the circumstances!

I think GP's have a checklist of 'things they must tell you' when diagnosing perimenopause/prescribing HRT. There certainly is a list in the NICE guidelines.

Thank you Herman. That is so reassuring.
Balance in my mind is what I need!
I think I held off too long. Covid didn't help either...

My Mum been trying to convince me to take this path for years. She went from pill to what she thinks was hrt which she stopped due to scare stories.

DinkyDaisy I definitely held off too long. Covid absolutely didn't help plus my sister and I were worried about the cancer risk (she's younger than me). But I had a particularly bad week back in September where I was in so much pain I could barely walk, my back, shoulders, arms and hands were so painful too. It was dreadful and I knew I just couldn't go on like it. Within about 5 days or so of starting the estrogen part of femoston that had all gone! I've had stressful situations since that would usually trigger neck/shoulder pain (from tension/cortisol out of whack, I think, very common in peri apparently) and I've had no pain at all. That in itself has improved my mental health.

I was told that breast cancer risk increases the longer you take HRT, and that once you start taking it, it is difficult to stop. So I didn't take it (this was about 10 years ago). I've just googled 'hrt and cancer risk' and there appear to be a number of recent articles suggesting similar?

@DinkyDaisy the scare stories are very old news and if I recall correctly, the study involved women in their 70s in the main so this skewed the results massively

I'm honestly in two minds myself but veering towards giving it a proper go and seeing how I get on. Have you seen all the preventative benefits? You don't want osteoporosis in your 60s

This is quite helpful

I too am going to do this 3 month trial.
I have got a reputation for being hyper anxious now and it is like I am a worse version of my former self. My ditsy, worry type 'qualities ' have been magnified. I embarrass myself lately and I need to give myself a chance to, hopefully, stabilise...

@FelicityFlowers I've been on HRT for years ( over12) so I read everything on risks and talk to my consultant about it. I am not blase about the risks an in some ways prefer not to use HRT but it helps other health issues I have.

I have every respect for Dr Newson but her latest information is slightly ambiguous.

Where she says that some types of HRT have no risk at all, she is talking about the use of Utrogestan.

The stats actually show there is no risk with 5 years' use.

This does seem to be the case and there are some studies showing no added risk after many more years. However, it's not absolutely certain that there is no risk.

The risks of ovarian cancer are not certain and if they exist are tiny.

@PlanDeRaccordement That research has its own flaws. I listened to the author/ researcher on the radio some time ago. She herself admitted there were limitations to her study mostly as it used observational and retrospective studies, not double blind controlled trials.

The other thing that is really important is that the use of Utrogestan is now common yet it was not used in the vast majority of research papers. There was some research recently in the press where they number of women using Utrogestan in the trial was 58 compared to hundreds of 1000s on the old types of progestin.

As always with any medication, there are risks.

You need to consider your own risks for other diseases.

Osteoporosis is one of the biggest causes of death in older women as is heart disease.

Your choice needs to balance your risks of one over the (possible) risks of another.

Every study has limitations. This is not the same thing as flaws or a flawed study. If it were flawed, it would have been withdrawn from publication.

@PlanDeRaccordement

Every study has limitations. This is not the same thing as flaws or a flawed study. If it were flawed, it would have been withdrawn from publication.

The WHI study from 20 years back was considered accurate at the time. So was the Million Women study. Both are now considered flawed.

Being withdrawn does not usually happen for decades when the study is evaluated again.

Yes, this one has its limitations, mainly that the type of HRT used by women in it is not what is being used by many women today.

That is a very important point.

It's been known for a long time ( 15 years ago I was told this) that it's the progestogen in HRT that is the possible cancer risk.

The use of Utrogestan is now common yet it's not included in most of these studies.

The ones where it IS considered - the French EN3 study and a Danish study (looking into cardio effects) shows no risks with it even long term.

My own view is there may be a small risk with any type, but women need to balance their own symptoms, and risks of bone loss and CVD, and decide what's best for them.

The increased risk of cancer exists OP and your GP is simply making sure that you are as informed as possible before prescribing .
If I were you I'd go back and talk it over with your GP .

If you want more info @FelicityFlowers, there is a lot of info online from specialists who will be able to tell you more than your GP.

Look at the Youtube videos of Nick Panay, The videos on the website of Dr Louise Newson, and the videos on the website of the British Menopause Society.thebms.org.uk/publications/bms-tv/

Other medical opinion is available ...

@baobun14

Other medical opinion is available ...

Not sure I understand @baobun14

What do you mean?

The examples I gave include a whole range of experts, from across the world.

Also, they aren't giving opinions, they are discussing research and stats.

I don't want to get into a pointless back and forth.
The drs you mentioned are known proponents of HRT.
A more balanced view would involve oncologists , those drs who are more cautious about HRT etc.
In any case, the gp is right ( why we feel the need to debate this is a mystery to me as none of us are qualified to do so - unless I'm wrong and you are a dr, if so , apologies ).
The GP was only doing due diligence in making the OP aware of the increased cancer risk . The incidence of Oestrogen linked cancers ( breast ovarian uterine ) is increased by using HRT.
You can debate on the head of a pin about how much the increase is but the fact is the risk is there.
The OP should talk to her dr - who knows her and her own particular risk profile

@baobun14 I assume you have not looked at any of the sites I mentioned, or watched the videos, and the BMS site especially.

I posted about those sites because they include a huge range of experts, including the types you would like to hear from.

Hope this helps :)

There is a small increased risk of both cancers for individuals on HRT. You do need to know that.. but in almost every case the benefits outweigh the risks, in that you are going to feel so much better.

You also have to remember that a small risk to individuals adds up to an increased number of people accessing cancer services on the NHS. So the NHS might well prefer that we sat around and suffered with our hot flushes, mood swings etc. as that may be cheaper in the long run.