Dispelling the myths of HRT and breast cancer in menopausal women

Menopause marks a time in a women’s life when estrogen levels fluctuate drastically and ultimately precipitously drop down to 1% of what they are before menopause. Women report significant symptoms and decreased quality of life. These symptoms include:

• Hot flashes
• Night sweats
• Irritability and mood swings
• Depression and anxiety
• Insomnia
• Palpitations
• Joint and muscle pain
• Vaginal dryness and pain
• Loss of libido

Additionally, there are well-documented risks for disease once a woman reaches menopause and stops producing estrogen, including Alzheimer’s disease, heart disease, osteoporosis.

You may ask yourself…Why would womens’ bodies be designed in such a way that we are susceptible to all these symptoms and adverse outcomes after menopause? And here’s the answer….

Thanks to modern medicine, the average life expectancy has more than doubled in the last 200 years from around 35 years old, to almost 80 years old! Simply put, from an evolutionary standpoint, our bodies have not had enough time to adapt to the longer life spans. Therefore, since the average age of menopause is 51, women are living approximately 35 years without the protective effects of estrogen. If that’s not a strong case for estrogen replacement therapy, I don’t know what is…!

So why has ERT been given such a bad rap?

Unfortunately, the myths surrounding the administration of HRT have women coming to me terrified to even consider it. Their symptoms have been dismissed by other providers and ultimately they are told this is a necessary stage of a women’s cessation of her reproductive life. If you do a quick search online you’ll see countless articles touting the terrible side effects of HRT and warnings that it causes breast cancer and heart disease. This is just simply not the case and women should not have To SUFFER through this stage of their life!

The myths around HRT evolved from poor study designs, faulty and biased interpretation of study data and data manipulation. Beginning with the WHI, researchers studied whether HRT had beneficial effects on heart, brain and bones- not cancer. Ultimately the WHI was halted due to an increased risk of breast cancer, heart attacks and strokes. To begin with, there were problems with the research design:

1. The average age of study participants was 63 years old (6), which is 10 years after the age of menopause. Obviously by the age of 63, the chance of already having comorbid conditions such as heart disease and cancer is increased.
2.  70% were severely overweight or obese (2)
3.  Participant had very high rates of high blood pressure (2)
4.  Women who were having symptoms of menopause were excluded because the dropout rate would be too high without placebo (no HRT). This means that participants who would have reported improved quality of life were statistically drowned out. (2)

At the conclusion of the study, before the journal was even published, the NYT headlined HRT as having no benefit on quality of life, and what’s worse…that there was an increased risk of breast cancer that was “almost” statistically significant. (4) This led to a precipitous drop over the next several years in women taking HRT as medical providers and women were fear-stricken by this report of the findings. (3)

The truth of the matter is that the results of the WHI concluded that there was NO increased risk of breast cancer for women taking estrogen alone and a less than 1% risk taking estrogen with progestins, which was not statistically significant. HRT was actually protective! (1) Several other studies such as the JAMA study and the Women’s Health Initiative have supported these findings.

In addition, interpretation of the data is reported as relative risk versus absolute risk, which in itself is deceiving. The method of reporting relative risk makes the risk appear inflated above that of what it really is. (3)

If you’re still not convinced here are a few more facts to consider about estrogen replacement:

1.  Women are twice as likely to die from dementia than breast cancer (2)
2.  The cure rate for breast CA is 90%, the cure rate for AD is 0%. (2)
3.  As many women die each year from fracturing their hip, as will die from breast CA. Estrogen is protective for osteoporosis, thereby decreasing the risk of fracture.
4.  Estrogen is effective in preventing colon cancer (2)
5.  Women can experience symptoms of low estrogen an average of 7.4 years (5) after menopause and up to 15 years after menopause
6.  In every decade of life the risk of dying from heart disease is 5 times greater than the risk of dying from breast cancer. (3) Estrogen is protective for heart disease.

What it boils down to is that women are suffering unnecessarily and quality of life for many women after menopause is terrible. Of course, there are a few considerations when deciding to pursue HRT, which is why it’s important that you find a qualified provider who will empower you and educate you to make an informed decision.

1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6386596/
2. https://podcasts.apple.com/us/podcast/avrum-bluming-m-d-carol-tavris-ph-d-controversial-topic/id1400828889?i=1000430560132
3. https://gero.usc.edu/AgeWorks/spring_session2015/tdl/gero510/diseases_d_lect/HormoneReplacementTherapy.pdf
4. https://jamanetwork.com/journals/jama/fullarticle/195120
5. https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2110996
6. https://jamanetwork.com/journals/jama/fullarticle/195120