HRT advice

[Sunflowerinmygarden]

Hello
After a recent celebrity having breast cancer on the news today. Im now totally panicking and so worried that I might get breast cancer. Im 47 started HRT 2 weeks ago, (the gel) and progesterone in the evening, im finally feeling amazing, brighter, more sharper in my thinking and clear head/eyesight. No more brutal hot flushes. However im now concerned ive put myself at risk of cancer.
I feel like I did in my 30s happy and full of energy. But now im paranoid.
What shall I do, stop the HRT or carry on for 5 years. 😢

Well perhaps not but oestrogen can be reabsorbed in the gut and it can convert to more inflammatory forms and so a high fibre diet is a good idea to reduce this and it has many other health benefits, so why not!

Where are you reading this? Can you link to science?

If this was so, why are consultants not telling women this?

https://thebms.org.uk/education/principles-practice-of-menopause-care/bms-ppmc-resources-toolkit/what-are-the-considerations-with-regard-to-hrt-and-breast-cancer/ Don’t panic, don’t make rash decisions. Instead have a look at reputable sources such as this

@clearveil The metabolites etc with estrogen are only there with tablet form and most women now use transdermal. This may be why the US is a bit behind the UK because they still use tablet form and often the older types - CEE. I agree with the rest of your post, but the link isn't about reducing or increasing BC risks and it doesn't differentiate between oral and transdermal hrt.

The important thing for @Sunflowerinmygarden to know is that for women starting HRT before 50 (including those with premature menopause in their 30s and early 40s) the 'clock' doesn't start till your are 50.

www.menopausematters.co.uk/risks.php

If HRT is commenced at a young age because of premature menopause, then the use of HRT up to the age of 50 does not increase breast cancer risk any more than in women who continue to have periods up to the age of 50. Additional risk from HRT only applies if it is then taken for more than 5 years after 50.

That link also says that HRT is unlikely to cause BC, but accelerates the growth of a cancer that is already there .

Also, the stats on the risks apply mainly to synthetic progestins, not micronised progesterone, which is safe for at least 5 years.

Do we have actual studies on the transdermal patches and micronised progesterone for more than 5 years? I plan to stay on HRT for as long as possible. I don’t want to come off it after 5 years. I can finally sleep again and surely that has to be good for my health!

If estrogen caused cancer then why does breast cancer increase after the menopause? When levels are low.

Why are breast cancer patients allowed to get pregnant after treatment? (estrogen levels are the highest in pregnancy…levels go on to the 1000s). Yet a low dose patch is contraindicated?

It’s all very confusing and so much more research is needed.

There are no double-blind, placebo controlled studies on any HRT (for example where 50,000 women are given dummy tablets/ patches but don't know which they are using.)

Estrogen does not cause BC- this is well accepted now. There are fewer cases of BC in women using only estrogen compared to women not using any HRT.

It's the addition of the progestogen that may increase the risk and at the moment there is a 'tier' of risk with synthetic types being more risky.

The research is observational. women complete questionnaires on if they used HRT, type, duration etc. Much of the info used is from women diagnosed with BC then compared with women who never get BC.

The concern is that some of this information from women is not accurate or that they may have had undiagnosed BC at the time using HRT (some drs say it takes 10 years for a tumour to grow and be visible on screening.)

There is some research which followed women for 12-14 years where mainly micronised progesterone was used and it showed no increase in BC.

These were not studies into HRT as such but the women were being monitored for other diseases and some did use HRT.

It's unlikely there will ever be any proper studies because why would women volunteer to take HRT very long term IF they had no symptoms and IF it might cause harm?

Using HRT long term should be taken as part of your 'whole health' and that includes risk of heart disease, bone loss, and how much your symptoms affect sleep, quality of life etc. IMO all women should have a bone density scan (NHS refuse this unless you've already had a fracture or strong family history) because for women under 60 HRT is the preferred treatment (in the BMS guidance.) That means many women may use it for 10 years or more.

Not sleeping long term is possibly more detrimental to your health than HRT- risks of diabetes, heart disease, dementia - so it's balance of risk/ benefits you need to make.

Thanks @JinglingSpringbells

That’s so helpful. I find it a shame that so many people avoid HRT because of a perceived breast cancer risk when so many other things have a much higher risk of this. Alcohol and being overweight included.

It’s interesting that some studies are now showing the opposite with regards to breast cancer risk.

More women will die of falls, heart attacks, strokes, dementia. And I know we can only say conclusively that HRT helps with osteoporosis but I do think there is some evidence out there to show it helps with heart health.

For me the benefits massively outweigh any perceived risks (which I haven’t seen any clear evidence for).

Always find it bizarre that people are happy to be on the contraceptive pill (synthetic hormones) for years and years. And the Mirena (again synthetic) but won’t touch transdermal HRT with micronised progesterone.

Transdermal HRT does reduce risk because it isn't processed though the liver on the first pass which is where certain risks emerge (clot risk for example) but hormones including our own natural oestrogen are still ultimately passed though the bowel and urinary tract where reabsorption and conversion to less useful forms of oestrogen can occur. Again eating a high fibre diet is one of the best things you can do for your health and the benefits to your hormones is just one of the those many benefits.

If people are posting with ‘facts’ they should declare the source or state that they are professionals in a certain field. It’s irresponsible

‘The Mindful Peanut’ website doesn’t look like a reliable source of information, for example

The 'facts' about the metabolites produced from oral HRT are true (put it into AI and check!) Most HRT now is transdermal.
But not sure how it's relevant to the post by the OP.

Thank you. Thats reassurance, im 50 in 2 and half years.

I don't think I've ever read such unscientific, unproven, scaremongering utter rubbish. I sincerely hope no one reading your posts takes any of it seriously regarding hormone 'reabsorption' and fibre 'flushing it out'

I find it a shame that so many people avoid HRT because of a perceived breast cancer risk when so many other things have a much higher risk of this. Alcohol and being overweight included'

It's because of high profile cases like Davina who is ultra fit but also a very vocal hrt advocate. It will put many women off. Obviously she could have developed bc anyway but it's that thing isn't it of not knowing, not knowing if you are taking a drug that actually increases the risk.

It’s not perceived, there is a higher risk I already am not overweight and barely drink . I’m doing what I can as it runs in my family. I am lucky I haven’t had many symptoms at 54 and last period age 51. Had about 6 months of night time sweating. I use vaginal oestrogen only as that’s the only change I’ve noticed and although it was mild dryness I didn’t want it to worsen.

It does increase the risk but only a tiny amount. As do lots of other things, again a tiny amount but by far the greatest risk is age. You can't avoid that one.

Of course. But I can reduce other risks. If I still get it I’ll know I did all I could. I’d hate to wonder if it was something g I did. My DM was on hrt for 10 years and got the oestrogen positive cancer in her late 60s. Her DM had 6 kids and didn’t have hrt and got it in her 80s.

I thought there was no increased risk with bioidentical HRT, even combined?

I really shouldn't look at these threads.
I am aware of risks and discussed with my gp. I am (touch wood) a fit 59 year old on Femoston conti ultra low. I will discuss again at my review just before I turn 60. That might be the time to stop (nervous about that) or look at low dose transdermal. I will particularly discuss progesterone as dygesterone seems to suit me ok and I know not available at the low dose I would likely want as an individual tablet. I will do more research before my review next June.

That's another 'myth' that has found its way online or wherever.

There are the same risks.

Doctors prefer to call it body identical because bio-identical was a marketing term. It's now used as the name for HRT that is made in small, unlicensed labs based on women's salvia tests etc. UK consultants do not recommend it.

@JinglingSpringbellssorry I did mean body identical e.g the bog standard utrogestan and oestrogel

I think people just don’t understand the concept of risk.

Women are much more likely to die of heart disease or a fall due to osteoporosis than breast cancer. Even women who have had breast cancer.

It’s as though people are worrying about the wrong thing. The benefits are huge and the risk is very small. For most women the benefits of HRT outweigh any risks (this is the official recommendations). Especially with the newer types.

Heart disease kills 7 times more women than breast cancer and this increases every decade.