HRT and cancer risks

[Fraudornot]

I’ve been on combined HRT for 10 years since I was 50. No problems and have found it a life saver for getting through menopause and functioning in a high level job. However, I’ve recently been worried about long term use and cancer risks but finding it difficult to sift through evidence online.
can anyone point me to some clear explanations of risk for long term use?

This might be of help.
It's a medical site and fairly balanced. One thing to bear in mind is that there are different risks, it appears, with the types of progestins. The differences are fairly small, but the highest risks are with synthetic types like Norethisterone , MPA and the Mirena coil, and possibly lower with Utrogestan. So if you choose to continue, you may want to swap to something different.

Ultimately, you need to decide if the benefits you are getting are worth the (possible) small risk.

Bear in mind too that the research and figures available do not include Utrogestan and are based on the older types of progestogen.

https://www.menopausematters.co.uk/risks.php

https://wwwmenopausematters.blogspot.com/2016/04/hrt-and-breast-cancer.html

had a talk from a doctor at work and the benefits for helping with menopause and preventing other illnesses really did seem to outweigh cancer risk. Wish I looked into it more before deciding against it.

@rose69 the risks seem to go up with long term use so it’s good to get definitive info on this too

@JinglingSpringbells so from the first link it shows that the risk of combined HRT goes up by +8 to +10 after 5 years use and is equivalent to the risk of I was either obese or drinking 6 units of alcohol daily. This is quite high risk to me and I need to give serious thought to coming off.

The figures are per 1000 women, over 5 years.
So that would be 8 to 10 more per 1000 women over 5 years.

(Based on the older types of progesterone, which you may or may not be using.)

10 in a 1000 is an increase of an additional 1% in 5 years (not each year.)

A lot of the data that is used is meta data (adding together ALL data over many
years) some of which is now proved to be flawed and it's based on the older types of progestins.

The other information - which is what many experts now believe- is that HRT promotes the growth of an existing cancer, not cause it. And that it would have developed anyway. This is in the first link too, by Dr Currie.

Maybe ask yourself why you went on HRT, have a 3 month trial without it to see how you are and if you still have symptoms.

Also look at your family history and consider if HRT might be preventing some diseases like osteoporosis, diabetes, colon cancer (which HRT protects against) and make a judgement on risks and benefits for you.

If you want to carry on, swap to Utrogestan perhaps and consider a sequential type (monthly cycles) as the combined continuous type has a higher risk (both hormones daily.)

It's not an easy decision, I appreciate that.

I am on Utrogestan already and 14 days progesterone per month. Rarely have a bleed though if that's relevant. Is there long term data on this? In the tables I thought the 5 and 10 year numbers were length of time on HRT or is that numbers increased over that time span.

If you're looking for definitive figures, there aren't any.
The figures in all the tables are based on old data and older versions of HRT.

In the links above, there are stats for 5 and 10 years on HRT, and the corresponding possible association with cancer.

This is one of many research papers on micronised progesterone. If you google, there are others.

https://pubmed.ncbi.nlm.nih.gov/29384406/

https://www.womens-health-concern.org/wp-content/uploads/2022/12/11-WHC-FACTSHEET-HRT-BenefitsRisks-NOV2022-B.pdf

Your own lifestyle may help in mitigating some of the risks.
eg Being active cuts the risk compared to women not on, HRT and inactive, by 7. See the table in the link.

https://www.womens-health-concern.org/wp-content/uploads/2019/10/WHC-UnderstandingRisksofBreastCancer-MARCH2017.pdf

There is no easy answer. If you feel worried, maybe come off it and see how you feel. And if you're okay, that's great. If you're not, consider if you are willing to take what is probably a small risk but you'd be benefiting in other ways (bones, heart, maybe offsetting dementia - jury out on that one- etc.)

I think we reduce our risks overall by having a healthy weight and not drinking alcohol. The stats on cancer risk and alcohol consumption are pretty bad (11 units a week increase your risk of cancer by 20%). So I figure if you are pretty healthy in all other areas of life then you will prob be fine with hrt.

Run four times a week and started weight training as I’ve hit 60. BMI around 20. Also trying to take in preventative measures of protection of bones as have seen the devastation that fractures in older women cause. Hard to know what to do really. No cancer on either side of the family either.

But do drink on the weekend - always no drinking during the week.

I’m no scientist but I reckon 2-3 units at the weekend with food is probably easy for the body to deal with. Sounds like you don’t have any other risk factors and are fit and well so low risk?