HRT Cancer Risks

[BatsInSpring]

This is pretty much just a rant.

I'm on HRT for a variety of perimenopause symptoms. I'm better on it but 6 months in I'm not sure if the dosage is right and it does still take up a lot of brain space. I still have symptoms, but they are lessened.
When I am trawling MN to read RL and shared experiences I come across a lot of threads where someone pops on to warn people about the risks (breast cancer mainly) of taking HRT.

How come I never seem to see comments from people warning of the risks of taking the COC or the POP?
Or of drinking alcohol?
I never see a comment like "it's all very well celebrities telling everyone to use contraception and have a glass of wine with dinner but the risks are very real and
lots of cancer specialists are still actually very worried about it"??
Aren't the risks of oral contraceptives higher than HRT? Especially given the length of time women would tend to use the two?
Isn't the risk of moderate (!) drinking exponentially higher than taking the newer HRTs?
Is it all because of the age we would generally take HRT compared to the age we would generally take the pill?
My GP was a bit reluctant to give me HRT but not reluctant to offer me the POP or the Mirena. Is that about money and targets rather than my health?
I was actually wondering about going on the COC and I'm 45. I haven't been on it for over 20 years. I think something that fully overrides my cycle might help the fluctuations that really make me suffer.

Hoping someone has done the hard work and has read all the data and can advise.

Risks compared to other lifestyle choices.

www.menopausematters.co.uk/pdf/Understanding%20Risk%20of%20Breast%20Cancer.pdf

Please also remember that the risks of BC in almost all the studies are based on synthetic progestins, not micronised progesterone (which supposedly has a lower risk.)

The risk of BC, according to the research in the diagram, is approx 4 extra cases per 1000 women, over 5 years, which is less than 1:1000 per year.

That was based on the old research, so it's possibly less.

Some women won't want to take any risk at all, but then they need to be aware of lifestyle factors as well that increase risks.

I can't comment on the risks of the COC. At 45 the risks are more about blood clots, so low dose pills are advised.

I haven't crunched the numbers, but I have read the patient information leaders that came with all the various forms of HRT I have used. Yes, the risk of cancer up to doubles for women using HRT. The highest risk is for breast cancer, at up to 48 cases per 1000 long-term users aged 50-59. Even though the percentage increase is large, that is a tiny, tiny number.

When weighing up the pros and cons of HRT, it is clear to me that the benefits outweigh the risks. Not just for osteoporosis and fragile skin, but for my mental health and my family's emotional wellbeing. If HRT shortens my life, so be it. I'd rather have 10 good years than 20 grim years.

I totally get what you say about the fluctuations. If you have no flags for serious risk in your medical history, go ahead. Take advance of having these drugs to improve your overall wellbeing. Don't worry about assessing all the risks of all medicines. The statistical analysis is not your problem and it's getting in the way of you addressing your needs. Though I admit I would find it very interesting!

@WashAsDelicates I've never seen that figure- 48 more per 1000?
Remember that a lot of the leaflets are out of date and based on the WHI trial which is no longer valid as it was flawed.

There is a different level of risk with progestins.
MPA= highest
Norethisterone= next highest
Micronised progesterone/ dydrogsterone = least

HRT is unlikely to shorten your life because even if there is a higher risk of BC (and some experts dispute this) the risk of dying from BC is no higher than for women with BC/not on hrt.

I know that's not exactly 'comforting' but it's a fact.

And statistically, women on HRT live longer than women not using it.

(Stats are out there is anyone wants to check- mainly the International Menopause Society etc.)

The other thing no-one mentions is that breast cancer does not mean death.

The highest cause of death in women is cardiovascular - which HRT helps prevent.

Vs a v small increase in the number of cases of breast cancer, which might not even be the case anymore as the HRT has changed, and which is highly treatable.

This. 💯

Isn't the highest cause of death in women now dementia? (Followed by CVD.)

The jury is still out on estrogen + dementia, but it's looking more and more likely that there is a link (ie preventative) especially as the highest level of dementia is in women.

Osteoporosis - not as 'alarmist' to many people as cancer, but over 1000 people (mainly women) each month die from a fracture

ilcuk.org.uk/wp-content/uploads/2018/10/OsteoporosisUK.pdf

I am in a work-related online group with lots and lots of women in their late 40s and 50s. SO many comments about flushes and brain fog and menopause.

I did make the mistake once of asking whether they'd ever heard of HRT and it was just one massive pile on. Everyone they know who had breast cancer was on HRT. The dangers of HRT are proven. Its so easy to treat menopause symptoms with zinc, magnesium, fresh juices. Why would you take "artificial" hormones?

It's really sad. It's clear from what these women post that many of them are struggling hugely but they are so scared about the risks of HRT that they haven't even looked at the benefits like protecting against heart disease or osteoporosis, or realised that their large glass of wine every night is more of a risk.

NICE does say that the risks of the POP are unclear but presumed to be similar to the COC and that age of taking, rather than duration, is where the small risk lies. Specifically talking about Breast Cancer here I think. So, at my age I'm presuming that the HRT I take (gel plus micronised progesterone) is safer for me than the pill. Which, I don't think most women would know.
So, that's interesting. The age limit guidance for both POPs and COCs has been raised and I wonder if that's in response to the demand for more expensive HRT.
I'm still considering the COC as a way to control the fluctuations but that's just today's meandering thoughts.
@JinglingSpringbells thank you for the graphic, very helpful.

So hopeful about this, what a breakthrough that would be!

I dunno what COC or POP are.
I do know that MNers are constantly dismissing the potential risks of HRT, more or less saying there are absolutely no drawbacks or adverse effects at all ever. That HRT cures almost everything & anything (females only) that might happen to your health after the age of 40. That any studies that say otherwise are LIES and anyone who raises the question about potential drawbacks is MISINFORMED. etc.

(off MN) Am pretty sure I've seen lots of infographics in last 10+ years comparing how different activities raise risk relative to background levels, as in one's life time risk of getting breastcancer might be X, and with HRT it's X+x. I like those infographics.

It's not clear that taking HRT has made OP a happier person, if this thread is how they want to spend their time (!)

I've never seen that figure- 48 more per 1000?

No, 48 per 1000, which is 21 more per 1000 than same age women not taking HRT.

The highest cause of death in women is cardiovascular - which HRT helps prevent.

The PIL for my HRT says HRT increases risk of clotand that there is no evidence of protection from heart attack.

However a risk doubled is still small when the background risk is small.

Protection from osteoporosis and dementia are significant benefits that far outweigh the risks. And protecting emotional and mental wellbeing are significant factors in preventing depression and addiction. Also far outweighing the risks.

Everything has a risk, @lljkk , all medicines have some sort of risk. I know that nothing is risk free and that there is a small risk caused by the patch on my bum giving my 75 mcg a day of oestrogen.

I do know though that my patch is less risky than taking the same dose in tablet form. I also know that I don't have a family history of breast cancer. I don't smoke and have never had a single cigarette, and the last time I had a glass of wine was mid-January.

I also know that the menopause hit my mental health so badly that without HRT I would not have been here as I was seriously planning how best to kill myself.

Women know that there are risks associated with HRT. However, many of us also believe that in the past these risks were overstated, and that there are huge benefits to take into account too.

And the dementia thing is great news. I currently have an elderly parent in residential care with dementia and it is the most evil condition which I would not wish on my worst enemy.

Some of us gently try to make the point that drinking more than a moderate amount of wine a week is a BC risk but we don’t get much support! People still think half a bottle a night is OK.

Quite. It's cultural. You get to the end of a tough day at work, nondairy beats an eyelid at "The moment I get home In cracking open the vino". If anything, they agree with you. But you say "The moment I get home I'm cracking open the Dairy Milk" people never join in. They even make a point of how they would never do that. Because chocolate is the evil fattener, but alcohol is just a bit of relaxtion.

So glad to hear you are feeling better now.

I had horrendous hot flushes during menopause and possibly other symptoms prior to that which I did not associate with menopause.
I thought about HRT but decided I could push through and not take the additional risk of breast cancer and I did.
I had no idea there were other benefits attched to HRT (this is 10 years ago not 50).
In the end I got breast cancer anyway, not all BC is hormone related and I also now have osteoporosis.
In hindsight I wish I had got HRT.
I would add though, that the other risk factors for breast cancer are often over emphasised. They are minute in comparison with the unavoidable risk factor of age.

Yes, quite right of course - the main risk factors for Breast Cancer are always going to be being female and getting older.
Thank you for sharing your experience and insight.
I hope you are on the mend now.

No, 48 per 1000, which is 21 more per 1000 than same age women not taking HRT.

@WashAsDelicates Are you sure you've got that figure correct? I've read pretty much all the research and never ever seen that. Would you link to it please?

It amounts to 26 more per 1000, which is FAR more than the diagram I linked to.
That 26:1000 would be more like the increased risk for women overweight (as per the diagram.)

The risk I've seen is 4:1000 more cases over 5 years, which is an increased risk of 0.4% over a 5 year period (based on the older types of HRT.)

I was advised to come off coc at 40, had doc apt at 43 re peri symptoms and was offered either her or the coc back.
I took up the COC option and 6 months later it's great, im level again 😀

@JinglingSpringbells This is the online PIL for the form of HRT I take. Page 4 www.medicines.org.uk/emc/files/pil.353.pdf

It's not clear to me what form of progesterone is being considered in these statements. Does it make a difference, for example, if the woman is taking oral progesterone or has a Mirena?

Thank you for linking.

TBH I'd not rely on information like that as it's not referenced. Any such stats should always be referenced to the source.

They could be using the WHI and the Million Women Studies which are now disregarded as flawed.

It's impossible to know where those stats are from.

One piece of information which I saw on the Chelsea & Westminster Meno Clinic (NHS) for prescribing said that drs should always try to prescribe micronised progesterone as it has 'a statistically non- relevant risk of BC'.

The Mirena gives the same amount of systemic progestin as a low dose patch (containing Norethisterone - although that's not the progestin in the Mirena..)

There is very much a difference with the type of progesterone and there are only a couple of studies that relate to micronised progesterone.

This is why the stats that are usually quoted are meaningless now, as they are based on synthetic progestins, trials done 20 years ago, and although many women still use those, many do not.

So are you saying that the risks are even lower than the already low risks discussed in the PIL?

@WashAsDelicates "I totally get what you say about the fluctuations. If you have no flags for serious risk in your medical history, go ahead. Take advance of having these drugs to improve your overall wellbeing. Don't worry about assessing all the risks of all medicines. The statistical analysis is not your problem and it's getting in the way of you addressing your needs."
This is good advice, thank you.