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Hormones: To Take or Not to Take

Hormones: To Take Or Not To Take

Many women see their 50s and 60s as the best years of their lives: children are on their way to independent lives, educational and carrier goals are fulfilled, financial security has become a reality. On the other hand, another reality of the age, menopause, is not comfortable at all. With hot flashes, sleepless nights, mood swings, “foggy” feeling in the head, urinary incontinence, low libido, weight gain, the list goes on and on.

Many women facing these issues know that hormone supplements can help with the symptoms of menopause, but aren’t aware that the correct  Hormone Therapy (HT) may also delay or prevent major degenerative illnesses such as osteoporosis, heart disease, colon cancer, bladder problems associated with vaginal atrophy, and possibly dementia.

The big question is whether HT puts women at increased risk of breast cancer.

Let’s look at the conclusions of the Women’s Health Initiative (WHI) study, complete in 2002. Its findings were discussed in all media circles, creating panic, fear and confusion about HT among women and doctors. As a result, since 2002 many women have been denied HT, including those with severe symptoms and low quality of life, creating a significant disadvantage for a whole generation of women. There are reports showing an increase in bone fractures in the last decade, attributable to the conclusions and decisions made based on the WHI study findings.

In the study, more than 16000 women aged 50-79 (average age 63) were placed on Premarin (horse derived estrogen) and Provera (synthetic progestin, not progesterone). Results showed an increased breast cancer rate (38 cases vs 30 cases per 10,000 person-year) for women who were on a combination of Premarin and Provera. Women who took only Premarin did not show any increase risk of breast cancer. It is clear that Provera (synthetic progestin) is the culprit. In the same study, the risks of heart disease, blood clots and strokes were assessed. Once again, women who were on both Premarin and Provera had higher risk of heart disease and stroke than those only on Premarin. If we look at multiple, albeit smaller studies -such as the ongoing ELITE study (at the University of California) – assessing bio-identical Estrogen and Progesterone (which chemically are exactly the same as our own hormones) we see a different trend: no increase in the risk of breast cancer and possibly a protection from heart disease and dementia, in women who take bio-identical hormones during menopause. The conclusion of this analysis should be summarized thus: Synthetic hormones given to older women (beyond 5-7 years in menopause) increase risk of breast cancer, blood clots and heart disease.

The present understanding is that HT may increase the growth of existing breast cancer cells, but it doesn’t cause cancer to begin with. Every woman who is considering HT should have a normal mammogram and clinical breast exam as a baseline.

We don’t know what causes breast cancer. About 5% of women with breast cancer (yes, only 1 out of 20) have a genetic predisposition to it. Women who are overweight, don’t exercise, or smoke have a higher risk, as do women who never breastfed their babies. Research is still ongoing on the subject of breast cancer causes.

Women who choose to go on bio-identical hormone therapy have a better quality of life: they don’t have hot flashes, don’t have vaginal atrophy and dryness, they sleep better, have younger looking skin and hair, and improved libido. As a result they are more likely to exercise and follow a proper diet, keep their weight under control and feel happier in general. The window of opportunity to benefit from HT seems to be within 5-7 years of onset of menopause.