Menopause Hormone Therapy: Study or Under-studied?

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menopause hormone therapy, WHI study, results, breast cancer

I know October was Halloween, but do we really have to scare every woman in perimenopause and menopause (PM&M) half to death….again????

I have read article after article, listened to the news and talk shows and I am getting more and more frustrated!  So, I began reaching out to the sisterhood, speaking with doctors, pharmacists and scientists about their thoughts on the latest findings of the recently released (October 20, 2010) follow up to the WHI 2002 study.

The 2002 WHI study on hormone therapy was halted due to the increased risks of breast cancer, stroke and heart disease in the women using Prempro vs. the placebo. Many scientists and doctors who have studied this report are quick to point out that the study was flawed, and the latest results and press coverage from it have perpetuated unnecessary fear.

The average starting age was 63 years old and many of these women were already on drugs for other conditions, including heart conditions. I am not good at math, but here is the part that sounds scary: a 1.3 person increase in breast cancer deaths per year for every 10,000 women.  Again, this is with specifically Prempro being used by mostly post-menopausal women.

Prempro is made up of conjugated equine estrogens (Premarin) and a progestin called medroxyprogesterone acetate (Provera).  These estrogens were derived from the urine of pregnant mares and therefore were comprised of estrogen made by horses.  I love horses, but this form of estrogen is not the same as what the human female body makes.

If you ask a room full of perimenopausal women today what kind of hormone replacement therapy they’re on, you would probably find that a tremendous number are on a transdermal bioidentical estrogen called estradiol and a bioidentical progestin called progesterone. These options, in contrast to  Prempro, are hormones that are made to be identical to the hormone produced in our bodies.

My head is spinning with questions:

  1. How does the 1.3 per 10,000 increases in breast cancer deaths relate in a risk/benefit analysis with the benefits of estrogen therapy, such as hip-bone fracture and heart disease prevention?
  2. Who is studying the PM&M woman who is on bioidentical hormones?  Is there a study that says a woman on transdermal bioidentical estradiol and bioidentical progesterone has an increase risk in breast cancer?
  3. If we start bioidentical hormones when we are in perimenopause, how long can we stay on these hormones?  For example, before age 60 is it beneficial to stay on HRT and then after age 60 does the risk benefit get reduced?
  4. Do we have a recent study on the affects of drinking/eating soy products?
  5. What does the existing international data on hormone therapy tell us about the affects of HRT on a woman’s lifespan?

PLEASE stop scaring us and start studying us!

After struggling with her own severe menopause symptoms and doing years of research, Ellen resolved to share what she learned from experts and her own trial and error. Her goal was to replace the confusion, embarrassment, and symptoms millions of women go through–before, during, and after menopause–with the medically sound solutions she discovered. Her passion to become a “sister” and confidant to all women fueled Ellen’s first book, Shmirshky: the pursuit of hormone happiness. As a result of the overwhelming response from her burgeoning audiences and followers’ requests for empowering information they could trust, Ellen’s weekly blog, Menopause MondaysTM, was born.

  • Dinah Arena

    I am 67, I have been off hrt for about 7-8 years, part of that time on anit-depressants. Having all the classic signs, insomnia, depression, NO short term memory, hot flashes, weight gain, headache, I made an appointment w/Medicare approved GYN, asking for bio-identicals. Answer “too risky, go back on anti-depressants”. Any thoughts??

  • Carol Ponsiek

    I am 48 yrs old and on Bioidentical progesterone. My problem is that I am Estrogen Dominant which is an entirely different type of problem. was on 2 other types of bioidential prgesterone prior to this one. Currently I use a cream made at a compunding pharmacy .5-1 ML per day. I’m on the lower (0.5 ml) right now but will increase after a few weeks. I unfortunatley have had some bad side effects from previous doses, so starting very low on this one. Please feel free to contact me with any questions, I hope I can help. Carol

  • Judith Burton

    I am so confused and furious with the scientific research and medical industry. Yes, I said industry because its been all about the money not the individual woman. I know everything is definitely not about me, but I want this one thing to be about me, right now. I have few choices in this it seems. I confess, a few times I have tried horse urine generated hormones for short time periods, but then dropped it based on fear of cancer. I have tried almost everything, at one time or another. Experimenting with just about every “solution.” Finally, the medical community is changing, I can’t even find a doctor that will prescribe Premarin any more, no matter how desperate I am for a solution. I have been using Amberen now for about a year. It has worked better than anything I have tried in the past. However, its not perfect either. I hope that by the time my grand daughters are facing PM&M, there will be a perfect solution. At this point in my life, 65 yrs., I’m pretty clear that if menopause and other hormonal problems affected men, there most likely would have been a solution a long time ago. Now, that there are more women in research, perhaps we will see even more movement toward solving these issues than we have in the past. I hope for my grand daughters.

    • E

      So true about men and the medical community. We need to demand more research for the shmirshkies! We’re making great progress and it’s only going to get better.

      Check out the NYTimes article I posted under Dinah’s comment. You might find that helpful.

      I’ve been looking into Amberen more closely as well – will let you know what I find.

  • Joseph F. Kennedy, MD

    Unfortunately, there is no data that says natural, bioidentical estradiol and progesterone are safe for menopausal hormone replacement. There are several studies of this underway but it will be some time before we have results we can use (It takes time for complications/side effects of low incidence to show up.). However, many physicians are using estradiol with or without progesterone for their perimenopausal patients. Until we have data from controlled studies this is an uncontrolled experiment. Therefore, it is imperative that every woman using hormone replacement therapy have a thorough discussion with her health care provider about the pros and cons, the benefits, risks and alternatives and assure themselves that they have no contraindications to hormone replacement and are carefully and regularly monitored for undesirable side effects. JFK

    • E

      Reaching out is IN. Suffering in silence is OUT!

  • Candice ganczak

    I want things to change in the passion department & had thought about testosterone therapy but that was excluded because I have high cholesterol. Is there any other therapy that can be substituted with good results. I have tried many different types of hormones but my bod just doesn’t seem to like them either – HELP.

    • E

      First thing’s first: do you have a great doctor that specializes in PM&M?

  • Jack Dolgen

    Hi E. great point!