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I am a 44 year old single mother of two beautiful children; Brian 20, and Nicole 17. Being a mom is the thing I am most proud of; I could sit and ta...
 
 
 
 

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Understanding the Latest Research About Hormone Replacement Therapy

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Field of WomenFor years there have been suspicions and studies linking Hormone Replacement Therapy (HRT) to breast cancer, but new research is now definitively linking HRT to an increase in breast cancer death rates.

It wasn't long ago that HRT was touted as a cure for menopause symptoms, that would also help your heart, your bones, and even prevent cancer.

  From the East Hampton Star -- Menopause Matters:

In his 1966 best seller, “Feminine Forever,” Robert Wilson touted the virtue of using hormone replacement therapy and derisively referred to menopausal women as “flabby” and “shrunken.” It was recently revealed by the journal PLoS Medicine and The New York Times that virtually all popular writing supporting hormone replacement at that time was being secretly funded by Wyeth, the manufacturer of these same hormone replacement drugs.

As I discussed in my Jan. 21, 2010, column in The Star, “No Fountain of Youth,” hormone replacement therapy, also known as H.R.T., will quell hot flashes and preserve bone, but it does not prevent heart disease or cancer.

Yes, there really was a time (and not too long ago) that women were told HRT could prevent both heart disease and cancer.  We are now learning that that couldn't be further from the truth.  From CNN -- HRT Increases Breast Cancer Death Risk:

This latest research looks at 11 years of follow-up on the health of these women and the authors found that those who had used the therapy were not only more likely to develop but to die from breast cancer.

For decades women have been prescribed HRT – medications containing female hormones to replace the ones the body no longer produces after menopause. These drugs can be very effective at alleviating the hot flashes, night sweats and other discomforts of menopause. They have also been shown to help with bone health and may decrease the risk of colon cancer. But HRT, long heralded as being protective for heart health, has not lived up to its billing and women are now warned about the possible increase risk for heart attack and stroke. Last year a study found that combined HRT also increased a woman's risk of dying from lung cancer.

From the American Cancer Society -- Advanced Breast Cancers, Higher Death Rate Seen with HRT:

“It’s a very strong paper. It clearly takes advantage of a well-conducted clinical trial,” says Susan Gapstur, PhD, vice president of the American Cancer Society’s Epidemiology Research Program. “These findings are adding to the growing evidence and concern about long-term effects of estrogen plus progestin.”

The new research, based on data from 16,608 women, found that compared with patients on the placebo, those who took estrogen plus progestin (in a formulation known commercially as Prempro):

  • had a 25 percent higher risk of invasive breast cancers
  • were 78 percent more likely, if diagnosed with breast cancer, to have more advanced cancers, which had spread to the lymph nodes
  • faced about double the risk of dying of breast cancer, and for those with breast cancer, a higher risk of dying of any cause.

Here is a great (eight minute) video with one of the authors of this latest study discussing this research...

When I was looking for more information to include in this post, I came across a "real life" story that brings the scientific jargon and statistics to the level of you and me.  This is a sad, but in the end inspirational, story of Carol Saline (author of the book Sisters), who was affected by years of hormone replacement therapy.  This is a small excerpt from the article -- Becoming the Story:

Somehow, through all the years of my sister's ordeal, I'd held on to a wholly irrational conviction that I would never get breast cancer. Was I stupid, naïve or just fooling myself? While neither Patsy nor I carried the BRCA genetic mutation (the marker for inherited breast cancer) and none of the women in our family had had the disease, I'd chosen to play the odds and stayed on

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kegill 5 pts

Hi, Catherine -- most news reports do not make it clear that "HRT research" is *really* research about the effects of Premarin/Prempro, drugs manufactured from pregnant mare's urine.

And the Women's Health Initiative was flawed in the sense that the average age of participants at the start of the study was 63; the average age of menopause in the US is 51. Thus, on average participants had passed through menopause a decade prior, and now their bodies were getting an estrogen shock. Moreover, the median age was considerably older (my memory says 67 but I'm not sure of that).

Finally, the WHI was curtailed not simply because of an increase in breast cancer or stroke but because the increased risks were greater than the benefits from hip fractures and heart disease. For a perspective on hysterectomy and research from someone with LCIS, see http://www.blogher.com/9-11-hysteria-and-womens-he...

Holyhormones 5 pts

My biodentical hormones (progesterone, testosterone cream transdermally, estriol cream intravaginally for dryness) would run about $90-100 per month if my insurance (and trust me, I have nowhere near the best insurance) didn't cover any of it, but after a protracted 13 month battle with the insurance company, they now cover about 60% of the cost. I argued with everyone I spoke to on the phone with BC/BS, and finally, one woman said to me "well, we can review this again, is it a chronic condition" and I shot back with "yes, ma'am, I am never going to be cured of being a woman". I thought I had really blown it, but 16 days later a check for a year's worth of back pay for the hormones arrived,and I have not had a problem with them since. My doctor in Southern CA(email me if you want his contact info), like most BHRT experts, does not take insurance, but he keeps his practice fees reasonable, as he wants biodientical hormone balance to be available to women of modest means. If anyone would like a list of resources to help you find a doctor in your area, and a list of my favourite books on the subject, please feel free to email me at holyhormones@gmail.com. Best wishes to all for hormonal health!

Catherine Morgan 5 pts

Hi Adela...Thanks for the additional link and information.

Contributing Editor Catherine Morgan
Also at Catherine-Morgan.com ( http://catherine-morgan.com/ )

TheBlackTortoise 6 pts

http://thewomanspace.wordpress.com/2010/10/24/nort... ( http://thewomanspace.wordpress.com/2010/10/24/nort... )

This is a concise statement regarding the data published in JAMA. NAMS is a health care professionals' organization (North American Menopause Society). Please read the comments, too.)

I could not look at the JAMA article on-line; probably because it is so new, as older articles about the subject are available. The abstract indicates it is an extension of the NIH study from several years ago. I was at the NAMS meeting when the NIH published the initial findings. I can tell you the members of NAMS were astonished at the reaction.

One thing to keep in mind with the NIH study: In order to study the heart health effects, the study purposely enrolled post-menopausal women. Many women's health professionals believe this skewed the data, even for the heart indications. Women who take estrogens peri-menopausal show improved heart health. (Non controlled study called the Nurses Study; women's habits and health is followed over many years time (decades).

Adela

Blogging at:

www.oncealittlegirl.wordpress.com ( http://www.oncealittlegirl.wordpress.com )

and

www.theblacktortoise.com ( http://www.theblacktortoise.com )

TheBlackTortoise 6 pts

I'll get back to you once I've read the article and looked at the data.

Adela

Blogging at:

www.oncealittlegirl.wordpress.com ( http://www.oncealittlegirl.wordpress.com )

and

www.theblacktortoise.com ( http://www.theblacktortoise.com )

Catherine Morgan 5 pts

October issue of JAMA - Estrogen Plus Progestin and Breast Cancer Incidence and Mortality in Postmenopausal Women

http://jama.ama-assn.org/cgi/content/abstract/304/...

Thanks for your comments, I'll check out your posts very soon.

Contributing Editor Catherine Morgan
Also at Catherine-Morgan.com ( http://catherine-morgan.com/ )

TheBlackTortoise 6 pts

The conjugated estrogens in Premarin and Prempro are not synthetic. They are extracted from the urine of pregnant mares. There are synthetic hormones, and there are some hormones synthetically manufactured. Those that are synthetically manufactured are the same molecular structure as those in our bodies or "bioequal". Synthetic hormones do not have the same molecular structure as our own, synthetically manufactured do.

Adela

Blogging at:

www.oncealittlegirl.wordpress.com ( http://www.oncealittlegirl.wordpress.com )

and

www.theblacktortoise.com ( http://www.theblacktortoise.com )

TheBlackTortoise 6 pts

FDA approved prescription drug, should be covered by insurance. You can get 'custom' formulation prescribed by a doctor and compounded by the pharmacist. However, compounded drugs do not go through testing for safety or efficacy, and stability is unknown. Although they are compounded from approved drugs, I personally do not go that route, because of the lack of stability data.

Adela

Blogging at:

www.oncealittlegirl.wordpress.com ( http://www.oncealittlegirl.wordpress.com )

and

www.theblacktortoise.com ( http://www.theblacktortoise.com )

TheBlackTortoise 6 pts

OK, Disclaimer: I worked in the pharma business. One product was estrogen replacement (not W/A). There's more research than you might think, just not in the public eye. There's are health care professional societies such as National American Menopausal Society, Canadian Consensus on Menopause and Osteoporosis, and independent studies done by NIH.

One of the problems is the data is dry and it is difficult to tease out meaning against the backdrop of so many individual variables. You can't just skip to the bottom line and get a few lines of conclusions. Another problem is the wrangling of big business interests (both in the pharma industry and where the advertising money goes.)

Adela

Blogging at:

www.oncealittlegirl.wordpress.com ( http://www.oncealittlegirl.wordpress.com )

and

www.theblacktortoise.com ( http://www.theblacktortoise.com )

TheBlackTortoise 6 pts

It looks like you've done your research. Good for you.

Adela

Blogging at:

www.oncealittlegirl.wordpress.com ( http://www.oncealittlegirl.wordpress.com )

and

www.theblacktortoise.com ( http://www.theblacktortoise.com )

TheBlackTortoise 6 pts

I wish to know the name of the recent study and a link if you have it. The study, please, not the media interpretation.

I spend time looking at the data and deciphering what it really says, not what the media interprets it to say.

I have a couple of posts about breast cancer and misinterpreted data. If you are interested please go to http://www.theblacktortoise.com. Click on the tab for "What's on my Mind." Two pariticular pieces: "Women Find a Fried in Fight Against Breast Cancer," and "Playing the Odds with Life." "What We do for Love" chronicles getting ready for my 60 mile walk a couple of years ago.

A couple of thoughts right off the bat: W/A Premarin is made from horse urine. It has all kinds of impurities in it. (If you break one open, you can smell something akin to a barn) Not everyone is prescribed Premarin or Prempro. The last study I read, and it's been a couple of years, indicates the pros outweigh the cons for women without a uterus.

I do not defend W/A. Still, the press can get a bandwagon going in a misguided direction.

Adela

Blogging at:

www.oncealittlegirl.wordpress.com ( http://www.oncealittlegirl.wordpress.com )

and

www.theblacktortoise.com ( http://www.theblacktortoise.com )

Catherine Morgan 5 pts

How much does it cost a month? And does insurance pay for it?

Contributing Editor Catherine Morgan
Also at Catherine-Morgan.com ( http://catherine-morgan.com/ )

Holyhormones 5 pts

I have taken bioidentical hormones for over 4 years (I wouldn't take that crap Premarin/Prempro on a bet --- those are synthetic hormones referenced in the WHI Study) and the improvement in my health is astonishing. Off seven medications, and the BHRT cured my hot flashes, restless leg syndrome, acid reflx, osteopenia and seasonal allergies in less than two weeks. I no longer take Ritalin for ADD. My focus, cognitive function and energy levels are terrific. Being hormonally balanced protects me from cancer, and boosts my immunity. My cholesterol has dropped 65 points. I am confident I am doing what is best for my health long term, and I expect to be on BHRT for the rest of my life. If anyone would like a list of recommended reading on bioidentical hormones, or a list of resources to find a practitioner in your area (or the contact information for myo wn physician in Southern CA), please feel free to email me at holyhormones@gmail.com. Best wishes to all for hormonal health!

Catherine Morgan 5 pts

Hi Erin. I think you're doing the right thing by getting all the facts, and I totally agree with not wanting to be suffering with menopause symptoms at 35.

I'm curious...Are the biomedical hormones the same as the bio-identical? And, are they covered by insurance?

Contributing Editor Catherine Morgan
Also at Catherine-Morgan.com ( http://catherine-morgan.com/ )

Erin Kotecki Vest 6 pts

I'm using biomedical HRT in the form of creams since my total hysterectomy 9 weeks ago.

I did one day of the surgical menopause thing in the hospital and wanted nothing more to do with it. Ever.

I need to look at this study further to understand how the biomedical and all natural stuff fits in. And if it was for a certain amount of years, or what.

Dammit. This makes me scared and confused. But I'm 35 and not wanting menopause now.

Politics & News Contributing Editor
Erin Kotecki Vest ( http://queenofspainblog.com/ )

Catherine Morgan 5 pts

Hi Mir, I totally agree, there are still a lot of unanswered questions. Not only the things you mentioned, but what about these bio-identical hormones? It seems that the questions are endless, and lets face it...This isn't a condition that only affects a percentage of women (it's all of us).

This type of thing always makes me wonder...If this was a "man's issue" would there be this much procrastination in research?

Thanks for your comment.

Contributing Editor Catherine Morgan
Also at Catherine-Morgan.com ( http://catherine-morgan.com/ )

Mir Kamin 6 pts

Okay, from a purely scientific perspective, I have a lot of unanswered questions which I fear this study doesn't address (and doesn't even point out as possible avenues for further exploration).

1) This looked at one specific drug, which combined both estrogen and progestin. What about unopposed estrogen? What about other combo drugs? [Sorry, I hadn't watched the video when I originally left this. Sounds like unopposed estrogen doesn't carry the same risk, so there's one question answered.]

2) Prempro is made from pregnant mare's urine. There's a plethora of more natural hormone replacement options available on the market today. Does a different source (e.g., plant-derived) affect the results?

3) What about age when supplementation starts? There was research around before this that suggested that if menopause is hit at the expected age, hormone replacement carries risks, whereas premature menopause presents greater health risks left untreated than appropriate hormone replacement until an older age.

I went into surgical menopause at 33. I am at very high risk for osteoporosis. At my current (young for menopause) age, you can rip the estrogen out of my cold, dead hands until I see more complete research that the risks of taking it are greater than those of going without. To my mind, this study doesn't say that.

--
Mir Kamin (BlogHer contributing editor)
Personal: Woulda Coulda Shoulda ( http://wouldashoulda.com/ )
Having it all with less: Want Not ( http://wantnot.net/ )