Estrogen/progestin Combination Hormone Therapy Causes Breast Cancer
On July 9, 2002, officials from the National Institutes of Health announced that one form of hormone therapy , Prempro, was found to cause breast cancer in previously healthy women. These women were volunteer participants in the Womens Health Initiative, the largest and longest trial ever of estrogen therapy and HT. The WHI began in 1991 as the first randomized clinical trial to look at the long-term health effects of post menopausal hormone therapy. Just over 16,000 women participated in this section of the trial. Half of the trail participants were given an estrogen/progestin combination in the form of Prempro, and the other half was given a look-alike placebo with no active ingredients. Prempro is a combination of a synthetic estrogen with a progestin .
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Does Hrt Increase The Risk Of Womb Cancer
The risk of womb cancer depends on the type of HRT.
Oestrogen-only HRT increases the risk of womb cancer. The longer this type of HRT is used, the bigger the risk. Thats why oestrogen-only HRT is usually only offered to those who have had their womb removed as they have no risk of womb cancer to begin with.
Combined HRT can reduce womb cancer risk. But combined treatment causes the biggest increase in breast cancer risk. So, its important to talk to your doctor about the balance of possible benefits and risks for you.
Similar to oestrogen-only HRT, tibolone also increases the risk of womb cancer.
Womens Health Initiative Studies Of Hormone Therapy And Cancer Risk
Several large studies have looked at possible links between systemic hormone therapy in menopausal women and different types of cancer.
The main randomized studies of MHT were part of the Womens Health Initiative . The WHI included 2 randomized placebo-controlled clinical trials of MHT in healthy women:
- One study looked at estrogen therapy in post-menopausal women who didnt have a uterus. Over 5,000 women in the ET group took a daily dose of estrogen in the form of conjugated equine estrogen for an average of about 6 years. The researchers then continued to follow them for several years to look for any further effects of the hormone. The women were compared to more than 5,000 in the placebo group.
- The other study looked at estrogen-progestin therapy in post-menopausal women who still had their uterus. Over 8,500 women in the EPT group took a daily dose of CEE plus a progestin called medroxyprogesterone acetate for an average of about 5 years. This group was compared to a group of more than 8,000 women in the placebo group.
The WHI also conducted some observational studies. However, when we mention a WHI study below, were referring to one of the randomized studies.
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What Does Phytoestrogen Have To Do With This
Soy products are very misunderstood and have also been on the debate radar. Just like hormones, not all soy products are created the same and not all have cancer-blocking benefits. Soy phytoestrogens occupy the Immune Building Receptor Sites and provide potent cellular immunity. It is also a great radiation reducer while providing nourishing iodine for the thyroid and reproductive organs.
In Walter Wainrights research, he found, The reduction of ER-a sites by the consumption of fermented, whole soy, not isolates from soy, like isoflavones, results in reducing circulating estrogen levels in women. This will slow down the growth of ER-positive cancers, not promote their growth. The excreted estrogens are the 4-hydroxyestrogens and 16-hydroxyestrogens that damage DNA cause and promote cancer growth. This reduction in circulating estrogens lowers the estrogenic index and is beneficial to the ER-Positive cancer patient.
The fermented, minimally processed, and Non-GMO soy products that I suggest eating are organic miso paste , natto, tempeh, and pickled tofu.
Haelan is a great supplement that contains a very concentrated form of bioavailable, supportive nutrients as well as protective phyto-estrogens compared to soy-isolated products, such as those found in soy-based protein powders.
In summary, if it is highly processed and filled with things you cant pronounce dont eat it regardless of what it is.
Is It Safe For Women Who Have Had A Cancer Diagnosis To Take Mht
One of the roles of naturally occurring estrogen is to promote the normal growth of cells in the breast and uterus. Some cancers also use estrogen to promote their growth. Thus, it is generally believed that MHT may promote further tumor growth in women who have already been diagnosed with breast cancer. However, studies of MHT use in breast cancer survivors have produced conflicting results, with some studies showing an increased risk of breast cancer recurrence and others showing no increased risk of recurrence .
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The Bioidentical Hormones Debate
We all know what it is like for our hormones to be out of wack. We feel it, and so does everyone around us! Not a pretty picture. Over the years, I have seen a pattern emerge again and again: estrogen dominance and not enough natural progesterone. This imbalance leads to a wide range of dis-eases and distress. Balancing your hormones isnt just essential for preventing mood swings and hot flashes. It is also critical for preventing serious health concerns such as polycystic ovarian syndrome , Endometriosis, pre-mature aging, and potentially breast cancer.
Many friends and medical professionals will tell you to take hormones, but not all hormones are created equally. Read on to learn about the different types of hormones, if they are safe for breast cancer conquerors to take, and what your next steps could be.
Are Bioidentical Hormones Safe For Breast Cancer Conquerors
As stated before, taking hormones is a personal choice between you and your doctor. During my second healing journey, I consulted with Dr. Lindsay Berkson. Dr. Berkson is a Hormone Scholar, Nutrition, and Gut Health Expert. She has been in practice as a nutritionist since the mid-1970s and an integrative nutritional/gastrointestinal endocrine specialist since the early 1980s. As a Breast Cancer Conqueror herself, Dr. Berkson specializes in complex cases, high-risk hormonal patients, and severe gastroenterology cases trying to avoid surgery. Berkson knows how to connect the dots of cutting-edge research and has a large background of personal clinical experience with success in difficult cases to pull from.
As Dr. Berkson plainly puts it, Hormones are the most misunderstood genre of medicine. It is the ignorance of many people in the medical community. New research on hormones is often not even discussed in medical school or future educational training. Please take 28 minutes to listen to my podcast episode with Dr. Berkson. Then, check out her website for the latest research, hormone tests, books, community programs, and consultations.
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Are Bioidentical Hormones Safe
The bioidentical hormones that are approved by the FDA have been tested for safety. They have passed the FDA’s strict standards and are safe for people to use. Like all hormone treatments, there are risks involved. You should weigh the pros and cons of even the FDA-approved bioidentical hormones with your healthcare provider.
Why Would A Woman In Menopause Take Hrt Some Women Take Hormone Replacement Therapy To Ease Menopausal Symptoms Hrt Is Medicine That Contains Hormones That The Ovaries Make Less Of As Women Age And Reach Menopause Hrt Can Be Taken As Estrogen Only Or As A Combination Of Estrogen Plus Progestin Combined Hrt Is Most Commonly Used Estrogen
Combined HRT may help relieve menopausal symptoms, protect against osteoporosis and reduce the risk of colon cancer.
Research shows that long-term use of combined HRT increases the risk of breast and ovarian cancer, heart disease, stroke and pulmonary embolism . The research suggests that the risks of long-term combined HRT use outweigh the benefits for most women.
The decision to take HRT is personal and should be made with the help of your doctor. Concerns about cancer, heart disease and stroke should be discussed when considering the benefits and risks of HRT.
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Does Bioidentical Hormone Replacement Cause Cancer
No, Bio-IdenticalHormones do not causecancer. A very large study called the Womans Health Initiative looking at hormonereplacement and chronic disease unfortunately gave the false impression that hormonereplacement was unsafe. This study used the synthetic hormone, Prempro- a combination of conjugated estrogens from horse urine and a synthetic progestin . ]
Reducing The Cancer Risks Of Hormone Therapy
If you and your doctor decide that MHT is the best way to treat symptoms or problems caused by menopause, keep in mind that it is medicine and like any other medicine its best to use it at the lowest dose needed for as short a time as possible. And just as you would if you were taking another type of medicine, you need to see your doctor regularly. Your doctor can see how well the treatment is working, monitor you for side effects, and let you know what other treatments are available for your symptoms.
All women should report any vaginal bleeding that happens after menopause to their doctors right away it may be a symptom of endometrial cancer. A woman who takes EPT does not have a higher risk of endometrial cancer, but she can still get it.
Women using vaginal cream, rings, or tablets containing only estrogen should talk to their doctors about follow-up and the possible need for progestin treatment.
For women who have had a hysterectomy , a progestin does not need to be a part of hormone therapy because theres no risk of endometrial cancer. Adding a progestin does raise the risk of breast cancer, so ET is a better option for women without a uterus.
Women should follow the American Cancer Society guidelines for cancer early detection, especially those for breast cancer. These guidelines can be found in Breast Cancer Early Detection.
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Is Bioidentical Hormone Replacement Therapy Approved By The Fda
This therapy is a not a new approach to hormone replacement it has been used since the 1930s. Bioidentical hormones are legal to prescribe and use in the US, although the FDA has not given its specific approval. The lack of FDA approval is because there are no official placebo-controlled studies to prove whether bioidentical hormones are safer than standard hormone replacement therapy.
How The Study Was Done
The study included 2,260 transgender women and 1,229 transgender men who were taking hormones and being seen at a specialty clinic in Amsterdam between 1972 and 2016.
On average, transgender women were 31 years old when they started hormone treatment and transgender men were 23 years old.
Transgender women took hormones for an average of 13 years, and transgender men took hormones for an average of 8 years.
During the study, 15 cases of invasive breast cancer were diagnosed in the transgender women at an average age of 50 and after an average of 18 years of hormone treatment.
This rate was higher than the rate of breast cancer in the general cisgender male population, but lower than the rate of breast cancer in the general cisgender female population.
Four cases of invasive breast cancer were diagnosed in the transgender men at an average age of 47 and after an average of 15 years of hormone treatment.
This rate was lower than the rate of breast cancer in the general cisgender female population.
This study found an increased risk of breast cancer in trans women in the Netherlands compared with Dutch cisgender men, the researchers wrote. In both trans women and trans men, the risk of breast cancer was lower than in Dutch cisgender women. This suggests that hormone treatment alters the risk of breast cancer in transgender people compared with initial risk based on their birth assigned sex.
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Interplay Between The Er And The Gr Or Mr
The MR has been shown to compensate for the absent GR during specific stages of mammary gland development , suggesting that the MR may play a similar role to the GR in breast cancer cell biology . Although the MR is expressed in most breast cancer tumors , little is known about its role in breast cancer pathogenesis. Nevertheless, the MR ligand, aldosterone, has been shown to increase breast cancer cell proliferation and migration via a mechanism requiring the MR and the G-protein estrogen receptor , also known as the G protein-coupled receptor 30 . This suggests that the MR is also involved in crosstalk mechanisms in breast cancer. Interestingly, at least one study has shown that the MR and ER-A can form a complex in HEK293 cells transiently transfected with cDNA expression vectors for the MR and ER-A , thus it is likely that a similar complex formation may be seen in breast cancer cells. Implications of this putative MR and ER-A crosstalk is not clear. Although beyond the scope of this review, both the GR and MR have also been implicated in crosstalk with the PR , emphasizing the importance of future studies investigating the cellular mechanisms of the GR and MR in breast cancer, as well as the extensive interactions between different members of the steroid receptor family.
Steroid Receptors As Mediators Of Hormone Activity And Carcinogenesis
aDunn et al. , Hammond et al. , Kuhl , Kuhnz et al. , Schindler et al. , Stanczyk et al. .
CBG, corticosteroid-binding globulin DRSP, drospirenone E1, estrone E2, estradiol E3, estriol EE, ethinylestradiol LNG, levonorgestrel MPA, medroxyprogesterone acetate NET, norethisterone P4, progesterone SHBG, sex-hormone-binding globulin.
A simplified representation of the structure of steroid hormone receptors. These receptors contain a variable N-terminal domain containing the ligand-independent activation function 1 region, a highly-conserved DNA-binding domain , a hinge region enabling flexibility, and a relatively conserved ligand-binding domain containing the ligand-dependent activation function region. ER contains an additional C-terminal domain of which the function is not known. The numbers indicated on the right represent the number of amino acids constituting each steroid receptor. Figure adapted from .. A full color version of this figure is available at .
Citation: Journal of Molecular Endocrinology 61, 4 10.1530/JME-18-0094
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Bioidentical Hormones And Cancer: Is There A Connection
Like most medications, hormone therapy has both benefits and risks. For some women, hormone therapy increases their chances of developing certain conditions such as blood clots, heart attack, strokes, or breast cancer. There is no concrete data exposing the risk of using these hormones however, for women that decide to seek therapy, it’s important to use the lowest possible dose for the shortest length of time.
Medical experts do not recommend long-term use of bioidentical hormones to relieve menopausal symptoms and suggest monitoring use with a complete risk assessment. Compounded bioidentical hormones have not been shown to prevent breast cancer they may actually increase the risk of the disease.
While some health risks are associated with these hormones after a short period of use, other health risks may not present themselves until years later. A major obstacle in understanding the actual safety of their use is that studies remain inconclusive about the risks associated with bioidentical hormones.
If your hormones are imbalanced and the body does not respond well to improvements in nutrition and exercise, you may want to discuss BHRT with your doctor. If you choose to incorporate bioidentical hormones into your menopausal treatment, additional factors such as nutrition, fitness levels, and lifestyle should also be adjusted to increase your overall well-being.
What Questions Remain In This Area Of Research
The WHI trials were landmark studies that have transformed our understanding of the health effects of MHT. Its important to note that women who were enrolled in the WHI trials were, on average, 63 years old, although about 5,000 of them were under age 60, so the results of the study may also apply to younger women. In addition, the WHI trials tested single-dose strengths of one estrogen-only medication and one estrogen-plus-progestin medication .
Follow-up studies have expanded and refined the original findings of these two trials. But many questions remain to be answered:
- Are different forms of hormones, lower doses, different hormones, or different methods of administration safer or more effective than those tested in the WHI trials?
- Are the risks and benefits of MHT different for younger women than for those studied in the WHI trials?
- Is there an optimal age at which to initiate MHT or an optimal duration of therapy that maximizes benefits and minimizes risks?
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Want To Learn More About Your Weight And Hormones
To make an appointment with Drs. McDonald or Wilson at OB/GYN Specialists, call 940-202-0566 today. You can also send us a message here on our website.
Our Denton, Texas, office is open Monday through Friday from 8:30am to 5pm to offer our patients the chance to ask questions, get informed, and start living the lives they most desire.
Where Does Evidence About The Health Effects Of Mht Come From
The most comprehensive evidence about the health effects of MHT comes from two randomized clinical trials that were sponsored by the National Institutes of Health as part of the Womens Health Initiative :
- The WHIEstrogen-plus-Progestin Study, in which women with a uterus were randomly assigned to receive either a hormone pill containing both estrogen and progestin or a placebo. The median duration of treatment was 5.6 years.
- The WHI Estrogen-Alone Study, in which women without a uterus were randomly assigned to receive either a hormone pill containing estrogen alone or a placebo. The median duration of treatment was 7.2 years.
More than 27,000 healthy women who were 50 to 79 years of age at the time of enrollment took part in the WHI hormone therapy trials. The goals of these trials were to see if MHT prevents heart disease and bone fractures in postmenopausal women and to determine if MHT affects risks of breast cancer and, for women with a uterus, endometrial cancer. Both trials were stopped early , when it was determined that both types of therapy were associated with specific health risks, but long-term follow up of the participants continues to provide new information about the health effects of MHT.
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