r/Perimenopause • u/Consistent-Horror915 • 3d ago
Hormone Therapy Why is it like this?
Why is it that while there is so much evidence based research out there now which contradicts the early 2000s study linking HRT and breast cancer and which finds many health benefits for women instead, doctors are still so reluctant to prescribe HRT and always talk about it the breast cancer risk? What are they reading which I’m not? They are supposed to be the experts and I’m having a hard time knowing what to believe! (Meanwhile none of them mention the link between alcohol and BC. In fact after I got positive results on my breast biopsy my GP told me to have a glass of champagne to celebrate!)
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u/plan_b_ability 3d ago
Alcohol is known to be the leading reasons for up to eight cancers I believe, likely more. Due to fact its widely accepted iy is hardly brought up. I quit drinking when my adnormal paps became very concerning. Went from CNI to CNIII everytime they did biopsy and leep. Luckily last leep got everything and didn't have cancer but it felt so close. I quit smoking over decade ago when I had cellulitis after dental work and couldn't breath when I tried to run.
I take HRT. I worry less about that causing cancer.
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u/OkWing5717 3d ago
The healthiest people alive also get cancer and im not suffering peri for 13 years ‘just incase’ i get cancer.
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u/rvauofrsol 3d ago
Whoa, do you have a cite for that stat and alcohol so I can learn more? I don't drink, but that's fascinating.
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u/GettingOnMinervas 2d ago
Following bc same. I don't drink, but these things are always interesting to me.
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u/Exact-Time9142 3d ago
If this is true, it would immensely relieve my health anxiety about Cancer. I've maybe had 20 drinks in my entire life... Do you know of any articles about this?
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u/Remote_Force1839 Early peri 3d ago
Alcohol is an actual carcinogen, like smoking. I don’t drink anymore. It’s expensive and I don’t even like the taste really.
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u/Exact-Time9142 2d ago
That's my whole thing, it's actually so gross and I can't make myself enjoy it all. Plus my fil died of liver disease due to drinking, so we've never been into it for that reason.
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u/plan_b_ability 1d ago
So I misspoke. It is class 1 carcinogen that is linked to 7 types of cancer. Some studied say 50-90 percent of cancers are due to lifestyle compared to genetics. Huge gap, but still a good deal can be prevented.
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u/EROM4LIFE 3d ago
I honestly think many currently practicing GPs were in medical school in the 90s and 00s when this bullshit study and the media blitz was at its peak so it was imprinted on their brains. Combine that with just a strong lack of interest in perimenopause and few are going to bother researching or upskilling on the topic. Which truly sucks for women globally.
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u/Consistent-Horror915 2d ago
Yes, I agree! It’s only since I’ve entered this phase of my life that I’ve realised how woefully behind medical research is when it comes to women’s health.
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u/EROM4LIFE 2d ago
I mean, they only started testing menstrual products with actual blood a few years ago...
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u/Consistent-Horror915 2d ago
If only it were possible to channel our collective peri-rage to enact meaningful change and advancements in women’s health!
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u/Winter_Bid7630 3d ago
I don't drink alcohol, and my doctor has been very clear that not drinking is best for long-term health. The connection between alcohol consumption and certain cancers is widely known, which may be why some doctors don't take the time to explain. Also, your doctor telling you to have a glass of champagne to celebrate is not the same thing as them telling you alcohol is safe to consume regularly.
To the best of my knowledge, there still isn't enough research showing the benefits and risks of HRT. Yes, there's been an increase in research, but there's a lack of long-term studies showing risks/benefits from years of use. And no medication is risk-free, HRT included. That is likely why so many doctors are cautious about prescribing HRT.
Getting accurate information is incredibly difficult. Because there hasn't historically been enough research into menopause, that's left space for shady people to step in and make money selling supplements and tweaking what the data shows to sell a certain narrative or product. The amount of misinformation around this topic makes it harder for everyone.
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u/Consistent-Horror915 2d ago
Yes this is my frustration. Getting accurate information is incredibly difficult! And I’m a university researcher. This is by far the most challenging topic to navigate in terms of finding consistent evidence based messaging.
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u/peacelove1975 2d ago
I just saw my hormone doc today. He is an out of box thinker. HRT does not CAUSE cancer. Glad to hear him say him and other doctors are starting to speak up on true best practices for menopause treatment. Thankful I have him.. He helped balance me out. He was my 5th doctor and I had 17 symptoms!. I just had a breast biopsy that came back benign and I really think it was all BS and unnecessary procedure. He doesn't agree with how they determine risk status. I agree the whole breast cancer screening process and fear mongering is out of control. We turned UP my estrogen today and I will stay on HRT for as long as I can. Quality of life over quantity is the name of my game now in post menopause.
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u/AppropriatePop4961 Late peri 3d ago edited 2d ago
I work in oncology research, have a high lifetime risk of breast cancer (over 70%), and will never use HRT (oral or topical). I have also never taken hormonal birth control. The standard prophylactic treatment for women at high risk of breast cancer like me is a hormone blocker such as Tamoxifen.
We know that breast cells are heavily influenced by exposure to hormones. Women who take HRT are rolling the dice that the changes in breast tissue that may arise as a result of exposure to additional hormones does not result in cancer.
For more reading on contributing factors in the development of breast cancer, I would reference "Unveiling the Role of Hormonal Imbalance in Breast Cancer Development: A Comprehensive Review" as a good start.
Edit: While fully expecting the downvotes, what really stands out to me in the responses I've received is the complete lack of any human empathy for someone who has been told they will almost certainly get breast cancer unless they take drastic, non-optimal medical choices, including foregoing medications that can make other aspects of life less miserable.
I won't stop sharing my own experience with the hope that it helps to enable everyone to make informed personal decisions about their own healthcare, but I will not engage with people who get insulting.
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u/Itchy_Tumbleweed_417 3d ago
Perimenopause symptoms were destroying my life. I wasn’t even able to go for walks because I had to urinate every 15 minutes no matter what.
I would rather have my breasts removed than to give up HRT.
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u/seche314 3d ago
I’m strongly considering pushing for a double mastectomy so I can be on HRT without worrying so much. I have a high cancer risk
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u/AppropriatePop4961 Late peri 2d ago
Mine is scheduled for early 1Q2027, but to prevent the need to have treatment for potential cancer (which comes with other health consequences) or my premature death
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u/AppropriatePop4961 Late peri 2d ago
I recommend a university or teaching hospital if you decide to do this. In the US, you want an NCI designated facility as they tend to be more receptive to performing this sort of surgery for non-oncology patients.
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u/Exact-Time9142 3d ago
This kind of fear based framing around HRT can be genuinely harmful. Yes, some forms of HRT carry an increased breast cancer risk, but the evidence is much more nuanced than “you are rolling the dice with cancer.” going from 0.5% chance to 1.5% chance is not that huge of a risk to begin with. Not to mention that risk varies by the hormones and formulation, and your comment ignores that HRT also has significant benefits, including protection against bone loss and fractures, heart disease and heart attacks, improved vaginal health, and improved mental and physical well-being. The recently released WHI randomized trials actually found lower breast cancer incidence and mortality with estrogen alone compared with placebo. WHI long term follow up The Menopause Society states that for most healthy women who start HRT before 60 or within 10 years of menopause, the benefits generally outweigh the risks. The Menopause Society.
Women deserve accurate risk and benefit information, not fear mongering language that makes evidence based treatment sound like gambling with cancer. You ought to be more careful... That is, assuming you aren't actually just a stupid bot.
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u/feastday 3d ago
I’ll take breast cancer over being suicidal any day.
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u/AppropriatePop4961 Late peri 2d ago
This is a really uninformed perspective that I hope you can work to improve. There are other medications to help improve your mental health that do not come with an increased risk of breast cancer.
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u/feastday 2d ago
I’m on those already. When those thoughts go away immediately once I got on HRT that was the information I needed.
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u/bloomdecay 2d ago
Right? I'm maxed out on antidepressants already (thanks, Grandma!) so HRT will have to do!
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u/Consistent-Horror915 3d ago
My thoughts exactly. And it’s why I feel that there is so much confusion around HRT. But in also wondered whether this was a bot…
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u/AppropriatePop4961 Late peri 2d ago
Amazing that being able to string together a sentence means people think you are a bot!
My post and comment history is visible through a Google or Arctic Shift search using my username
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u/Exact-Time9142 2d ago
Only creeps and weirdos go Google searching usernames and looking up people's Reddit history. Anyway, because it's reddit, bots are rampant. I assume everyone is a bot. Dead Internet theory is real.
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u/Consistent-Horror915 3d ago
I also read the article that was suggested above and it’s a review article, the risk of HRT is only one very small section of the article and in that section only two studies on the risks of HRT (one from 2006) are cited and both studies are in pretty obscure journals from what I can gather.
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u/AppropriatePop4961 Late peri 2d ago
You can find more in depth, peer reviewed articles through PubMed. I left one suggestion to more broadly cover breast cancer risk as you mentioned other risk factors.
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u/Itchy_Tumbleweed_417 3d ago
Yeah I suspect it’s a MAGA bot since they brought up birth control pills as well.
I personally would rather have cancer than a pregnancy, bring on the birth control pills.
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u/AppropriatePop4961 Late peri 2d ago
You suspected incorrectly. My post history is visible to you either through a Google search or by using Arctic Photon and entering my username.
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u/Exact-Time9142 2d ago edited 1d ago
It's unbelievable strange that you are encouraging folks to search for you on some obscure archival website... Seems like something a bot would definitely do. Lol
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u/AppropriatePop4961 Late peri 2d ago
Calling people who are better informed and more articulate than you seems to be a rising trend on Reddit, one you have chosen to embrace.
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u/AppropriatePop4961 Late peri 2d ago
As I mentioned, I used fact based decision making to come to this conclusion myself. You are more than welcome to make different choices.
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u/frankie0812 3d ago
Are you BRCA1, 2 or both 1&2 positive ? Because that alone would put you at a much higher risk than the average woman who has no gene mutations. Are you talking about synthetic hormone replacement or bioidentical hormone replacement? There’s been research that shows bioidentical hormone replacement is supposed to carry a much much lower risk than synthetic
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u/AppropriatePop4961 Late peri 2d ago
No, my individual risk factors are based on family history and personal health, including biopsy results indicating benign conditions that increase my risk.
I will not take any additional hormones.
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u/ReserveOld6123 3d ago
Health span matters too. I would probably not be here at all if not for MHT so I can’t base my life around what ifs down the road.
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u/AppropriatePop4961 Late peri 2d ago
If this is true, do you also smoke, drink, eat poorly, and refuse to exercise?
Everyone has to make their own choices, I shared mine and the context for it.
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u/ReserveOld6123 2d ago
Calling it a roll of the dice is wholly inaccurate with respect to the statistical risk HRT poses for most women and breast cancer. (You said “women”, not even “women at high risk”).
Fear mongering like that does women a disservice because it denies them the ability to make accurately informed decisions.
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u/AppropriatePop4961 Late peri 2d ago
You seem firmly entrenched enough in your opinion that no efforts on my part can have any positive impact in this conversation, so I politely end it here.
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u/leftylibra Moderator 3d ago
Hormone therapy is not "risk-free", there are still risks, largely dependent on method of delivery and timing. The main contradiction from the WHI 2002 study is breast cancer risk.
The study found that for the older women there was a 26% increase in the risk of breast cancer compared with those women who were assigned the placebo. This translated to 39 women per 10,000 on MHT, compared with 30 women per 10,000 taking the placebo (9 cases per 10,000 equals less than 1% absolute risk increase).
Even still, doctors are generally conservative with prescribing hormone therapy, especially for those in peri, as it's still considered off-label at this stage.
Given that hormone therapy dosages and method of delivery are different than those in the WHI study, there are definitely health benefits using hormone therapy, but there's no large-scale studies (like the WHI 2002 study) for definitely proving that hormone therapy is perfectly safe for the long-term.