Have you wondered if hormones cause breast cancer? A new study from Denmark published in BMJ dispels this thought and gives very encouraging evidence that HRT (hormone replacement therapy), when done appropriately, can provide many life saving benefits to women.[1]

Louise Lind Schierbeck and colleagues analyzed data from 1006 women who had recently gone through menopause were randomized to HRT of no HRT. After 16 years, the group not taking HRT have almost a third more mortality from heart disease compared to the group on HRT without an increase in risk of breast cancer or stroke.

The bottom line of the study is depicted in this graph. It shows the proportion of women who were alive at any one year comparing those on HRT (HRT group) versus those not on HRT (Control group). It basically demonstrates how women who took estradiol, a bioidentical type of hormone, had less chance of dying overall than those women who did not take the hormones. The reduced risk is about a third (32.5%), mostly due to a decrease in cardiovascular disease, which is the number one killer of women.

The results of the study can be summarized in the following chart that demonstrates whether there was a difference or was not a difference in the risk of developing the medical condition with HRT, or if hormone therapy was taken versus not taken. There was a decreased risk of developing medical problems due to cardiovascular disease while not increasing the risk of other problems, including breast cancer.

Medical Problem
No Difference
Decreased Risk with HRT
Increased Risk with HRT
Mortality -Death (MI or HF)
Yes
No
Heart Failure
Yes
No
Heart Attack (MI)
Yes
No
Stroke
Same
 
No
DVT (deep vein thrombosis)
Same
 
No
Pulmonary embolism
Same
 
No
Any cancer
Same
 
No
Breast cancer
Same
 
No
Death from HF or MI
Same
 
No

The patients taking HRT used Estradiol, a bioidentical type of hormone, and a progesterone that was not the same synthetic type as used in a prior study (the WHI). An even better result may have occurred if natural progesterone had been used, since bioidentical progesterone seems to have a more beneficial effect on the cardiovascular system than do the synthetics.[2], [3]

The authors found that “In this randomized trial including 1006 women we found a significantly decreased risk of the composite endpoint of death, heart failure, or myocardial infarction when hormone replacement therapy was started early in postmenopause” and there was no increased risk “of cancer, stroke, deep vein thrombosis, or pulmonary embolism.” The risk of developing breast cancer, in particular, was the same whether HRT was used or not used.

However, if one evaluated just the women who had had a prior hysterectomy and only took estradiol with no progesterone, there was a significant reduction in the of breast cancer in the group taking just estradiol. This observation actually was already noted in the WHI study.[4] In the WHI study, those authors had concluded that women shouldn’t take hormones after menopause, yet this present study essentially negates that conclusion.

Schierbeck and the authors conclusion was: “Our finding suggest that initiation of hormone replacement therapy in women early after menopause significantly reduces the risk of the combined endpoint of mortality, myocardial infarction, or heart failure. Importantly, early initiation and prolonged hormone replacement therapy did not result in an increased risk of breast cancer of stroke.”

At the office of Dr. Robert L. True, we have been firm advocates for improving the health and quality of life of women while limiting risks. This study confirms our conviction of using HRT, particularly bioidentical hormone therapy, to achieve this worthy goal. If you are postmenopausal and would like to reap these benefits, call us for an appointment today at 817-399-8783. There is no point in suffering from poor quality of life postmenopausal due to lack of hormones.

 

References:

[1] Schierbeck, Lind Schierbeck, registrar; Lars Rejnmark, associate professor, consultant; Charlotte Landbo Tofteng, staff specialist; Lis Stilgren, consultant; Pia Eiken, consultant, senior endocrinologist; Leif Mosekilde, professor, senior consultant; Lars Køber, professor, consultant; Jens-Erik Beck Jensen, associate professor, consultant. “Effect of hormone replacement therapy on cardiovascular events in recently postmenopausal women: randomised trial” BMJ 2012; 345, October 2012. http://www.bmj.com/content/345/bmj.e6409

[2] Simoncini T, Mannella P, Fornari L, Caruso A, Varone G, Genazzani AR. In vitro effects of progesterone and progestins on vascular cells. Steroids2003;68(10-13):831-6.

[3] Rosano GM, Webb CM, Chierchia S, Morgani GL, Gabraele M, Sarrel PM, et al. Natural progesterone, but not medroxyprogesterone acetate, enhances the beneficial effect of estrogen on exercise-induced myocardial ischemia in postmenopausal women. J Am Coll Cardiol2000;36:2154-9.

[4] LaCroix AZ, Chlebowski RT, Manson JE, Aragaki AK, Johnson KC, Martin L, et al. Health outcomes after stopping conjugated equine estrogens among postmenopausal women with prior hysterectomy. JAMA2011;305:1305-14.