• Hormone Replacement Therapy and the Distortion of Details
Posted by Joseph F. McWherter, MD on August 5, 2013
As a gynecologist with decades of experience in tailoring hormone replacement therapy for my female and male patients, I am frequently asked many questions regarding HRT. Two of the most frequent questions are:
Will I get breast cancer from taking hormones?
How long should I be on hormone replacement therapy?
The answer to these two questions involves a consideration of the patient’s biologic individuality, life expectations, compliance with an anti-inflammatory lifestyle program (like the FEM Centre program I recommend to my male and female patients). Recent publications analyzing previous hormone replacement studies also provide useful information in deciding how to answer those two questions.
Eleven years ago, in July 2002, a Women’s Health Initiative (WHI) study was prematurely halted as a result of the Estrogen plus Progestin Trial (PremPro) report of unexpected adverse effects in women receiving PremPro, compared to those on A placebo. I can recall the exact day because I began to receive phone calls at my office from local media asking my opinion on, “the risks of hormones causing breast cancer.” My response, as you may have already predicted, was, that “hormone replacement with synthetic hormones containing progestins” should be avoided; instead, I prefer the use of bio-identical hormones for hormonal replacement.
Today my response, although the same, is based upon more complex medical data accumulated 11 years post the WHI study. This most recent data warrants further discussion, since it could literally save women’s lives. Bio-identical hormones:
- fit the body’s genetic blueprint,
- permit hormonal levels to be measured in conventional laboratories,
- have the ability to be metabolized into cancer-fighting molecules based on proper lifestyle and supplementation, and
- have a biologic window of opportunity for replacement, after which they are no longer as effective.
An unintended consequence of the halting of the PremPro leg of the WHI study was a media-precipitated knee jerk reaction – that hormone replacement (in general) causes breast cancer. This misconception was worsened, not only by the suddenness of the WHI committee announcement, but by the lack of proper Committee clarification, which should have been included:
- The WHI study contained multiple trials, including an “estrogen only or Premarin” leg, which was not cancelled,
- The women in the WHI were first time users in their 60s, which does not reflect the population of women from 50 to 59 who most commonly seek hormone replacement, and
- Only oral formulations specifically limited to Premarin and Provera combinations were used, ignoring pharmaceutical estradiol patches and oral bio-identical progesterone mixed in peanut oil (Prometrium).
Based on this misdirected sensationalism, over 50% of menopausal hormone users, regardless of hormone type, abruptly stopped their treatment. Eleven years later, and without the media hype, we can finally make sense of what the WHI and similar trials such as the California Teachers Study were telling us.
- As of 2012, the WHI-estrogen only (ET) (Premarin) trial investigators reported a 63% reduction in mortality because of invasive breast cancer in the post intervention study of ET users versus placebo users, and
- Women who begin estrogen therapy within ten years of the menopause have a significant decline in heart disease and all-cause mortality, including cancer deaths. In other words, they are living longer and healthier.
A recent publication, coauthored by a Yale Professor of OB/Gyn, examined the impact on the health of that portion of the 50% who were between the ages of 50 and 59 and on estrogen-only therapy (presumably because of a hysterectomy) but had suddenly stopped replacement therapy. His findings were both startling and worrisome.
Almost 50,000 of these women suffered premature death over a 10 year period as a result of stopping their estrogen replacement.
As noted in this article, “Distortion of details can prove to be nothing less than lethal.”
My advice is: Do not always believe what the media says, especially regarding medical treatments. Find a trusted source for information, do not become a victim of the medical “herd mentality”, and realize that important medical information may be ignored by popular media outlets…for whatever their reasons.