Is Menopause Hormone Therapy Safe? – What You Need to Know
By Dr. Khanh Perrin
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Are There Risks with Taking Hormones?

This is one of the common questions that we hear from new patients. To answer this question, we look to the latest review of the Women’s Health Initiative (WHI) by Dr. Rowan Chlebowski and colleagues, published in July 2020. The WHI study was the original investigation that, in July 2002 declared that hormone replacement therapy (HRT) increased the risk of breast cancer, heart disease and strokes. At the time, one part of the study was prematurely stopped because of the negative results. This news caused an avalanche of women to stop hormone use.

What Does The WHI Follow-Up Analysis Say About Breast Cancer?

Since that time, follow-up analyses of the WHI participants have been conducted periodically. The WHI study had two groups.

One group took a synthetic estrogen called conjugated equine estrogen (CEE). The other group took combination CEE and a synthetic progestin called medroxyprogesterone acetate (MPA).

Findings Of The Synthetic Estrogen Only Participants Of The WHI

In this latest follow-up analysis, after 20 years and98% of participants information collected, Dr. Chebowski found that the women who took conjugated equine estrogen (CEE)only had a lower incidence of cancer than study participants who did not take hormones. Not only did the women taking CEE only hormones have a lower rate of cancer, but the death rate from breast cancer was also lower than the death rate of participants who did not take hormones. Here are the exact numbers below.

Findings Of The Synthetic Estrogen And Synthetic Progestin Participants Of The WHI

The same, however, cannot be said of the study participants who took both CEE and synthetic progestin MPA. In the women taking CEE and MPA, there was an increased incidence of breast cancer. There was no difference in the death rate of women on CEE and MPA and women who were not on hormones. Here are the exact numbers below.

Based on the WHI analysis, we can see that women should never take synthetic progestin on a long-term basis. Long-term progestin use will increase a woman’s risk of developing breast cancer.

What Does The WHI And Other Research Say About Hormones And Heart Health?

The WHI not only followed breast cancer risks, but it also followed heart health. After all, the WHI was funded by the NIH to see if hormones might be a beneficial treatment for aging women and the rapid rise of chronic illness seen inthe1990s. There was fear that the chronic illnesses of diabetes, hypertension, and heart disease would bankrupt Medicare.

What did the WHI study show? In the subset of women who were less than 60 years old and who had started HRT within 10 years of menopause, there was a decreased risk of heart disease, heart attacks and heart bypass surgery. However, as the baseline age of the women in the WHI study was 63.4 years old when they were enrolled, most women in the WHI did not meet these criteria. Consequently, the official conclusion of the WHI was that HRT is associated with an increased risk of heart disease. This is where the ELITE (Early Versus Late Intervention Trial With Estradiol) study comes in to clear up the confusion.

The ELITE study was created to determine if starting HRT early is heart-protective.As can be inferred from the name, there were 2 groups of participants in this study. The early group participants were classified as women who were within 6 years of menopause. The late group participants were 10+ years from menopause. The ELITE study found that HRT slowed the progression of plaque build-up on arteries compared to placebo or women who did not take HRT only in the early participant group. This phenomenon is called the timing hypothesis. The timing hypothesis proposes that the cardiovascular effects of HRT depend on how closely it is started in relation to menopause. Women who start HRT closer to menopause will see more benefits. Women to start HRT further away from menopause will see less benefit mostly because the process of lipid plaque build-upon heart arteries may have already developed.

What Is Our Experience?

In our practice, we are fortunate to have exceedingly few patients who have been diagnosed with breast cancer. Of those women who were diagnosed, almost all of them were receiving care for general functional medicine health and were not on HRT. Breast cancer is a complex topic and based on the WHI findings, is not increased with HRT. Infact, new research suggests that breast cancer is initiated by stem cells.

How Should A Woman Go About Deciding If Menopause Hormone Use Is Right For Her?

Working with a team specializing in hormone replacement optimization is the first place that every woman considering hormone replacement therapy should start. Almost every medical therapy has risks and benefits. By working with a hormone optimization practice, patients will get a clear picture of their personal situation. At Craft Care, our patients undergo testing not only with annual mammograms but also periodic pelvic ultrasounds, online memory testing, coronary calcium testing, heavy metal blood testing, and nutrient genetic testing. This data gives our team the necessary information to guide patients on their best healthcare path.

References:

1.https://jamanetwork.com/journals/jama/fullarticle/2768806
2.https://www.nejm.org/doi/full/10.1056/nejmoa1505241
3.https://www.cedarssinai.org/newsroom/study-hormonereplacement-therapy-may-help-improve-womens-heart-healthoverall-survival/