#56: 💊 Hormone Replacement Therapy
The controversy around HRT, should women do it and the alternatives.
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💬 In this note:
💊 Hormone Replacement Therapy
📚 Estrogen Matters
⚡️ The Pet Rock Training Guide
💊 Hormone Replacement Therapy
No one seems to agree about hormone replacement therapy.
Is it safe?
Will it cause breast cancer?
Some people say it’s life-changing.
Some are scared to take it, thinking it’s dangerous.
Let me help try to distinguish myth from reality.
First, let’s get information.
What is Hormone Replacement Therapy?
The menopause transition represents a significant change in a woman’s lifetime, marking the end of her reproductive years with the decline of the ovarian follicles and consequently endogenous estrogen.
Nearly 80% of women worldwide suffer from menopause-related effects that can range in severity and affect quality of life and overall health.
Hormone replacement therapy (HRT) was created to bring relief from those symptoms and improve a woman’s health. It involves taking synthetic forms of the hormones estrogen and progesterone to replace the declining natural levels during menopause for women.
HRT is sometimes called hormone therapy, HT. Taking estrogen alone is called estrogen replacement therapy (ERT) and is typically given to women who have undergone a hysterectomy (removal of the uterus). It’s not prescribed to women with a uterus because ERT is associated with an increased risk of endometrial cancer, which can’t occur when you don’t have a uterus.
Luckily the risk of endometrial cancer is mitigated when estrogen is combined with progesterone.
And that’s why HRT contains both estrogen and progesterone.
Ladies, those two hormones should sound familiar.
Estrogen and progesterone cycle in our bodies during our month’s cycles and they are the hormones present in birth control that has been prescribed since the 1960s.
As a menopause therapy, HRT was first marketed to aging women in the 1940s. HRT rose to peak popularity in the 1990s.
It was the gold standard treatment for symptoms of menopause and perimenopause (the ~10 years leading up to menopause where symptoms may start to appear).
During this time, most if not all American women going through menopause were encouraged by their doctors to take HRT for their hot flashes, mood swings, insomnia, brain fog and weight gain.
Over 6 million women were taking HRT in the 90s.
Then in 2002, a large women’s study by the Women’s Health Initiative (WHI) published shocking results which showed an increased risk of breast cancer, blood clotting and stroke for women on HRT.
The results of this study sent the media into a frenzy. Panic and fear around HRT spread quickly and many women stopped treatment immediately.
Suddenly it was close to impossible to get a prescription for HRT. No doctors would prescribe it for fear of the increased risk of breast cancer. Prescriptions dropped by 70%.
Now, over 16 years later, several doctors are challenging the results of the WHI and looking at the statistical analyses of the study with more care.
For example, Longevity expert, Dr. Peter Attia, says in his blog “Clearing the air on HRT”
“Let me be very clear: HRT is unquestionably the single most effective available treatment for easing the symptoms of menopause. Despite the WHI’s reports and subsequent alarmist media coverage, no one disputes HRT’s efficacy in relieving menopausal symptoms and thereby improving quality of life. Rather, the debate lies in whether this relief comes at a cost of raising one’s risk of certain chronic diseases, particularly breast cancer, dementia, and cardiovascular disease.”
To put a stop to the most effective available treatment for menopause is a big deal.
The risk that most women associate when they think of hormone replacement therapy is with breast cancer due to the press avalanche after the WHI publication with several headlines stating, “HRT linked to Breast Cancer.”
The statistic that is often quoted and raises fear in women is that a woman has a 1 in 8 chance (12%) of developing breast cancer.
But this statistic is taken out of context.
The book ‘Estrogen Matters’ (also, this week’s Book of the Week) breaks it down.
A 30 year old woman has a risk of developing breast cancer in the next decade of 1 in 227 (0.4%)
A 40-year-old woman has a decade risk of 1 in 68 (1.5%)
A 50-year-old woman, 1 in 42 (2.4%)
A 60-year old woman, 1 in 28 (3.6%)
A woman over 70, 1 in 26 (4%)
How did the 12% risk statistic get stuck in everyone’s heads? It’s still the statistic that is the first hit on google when you search breast cancer incidence.
Well, the media (incorrectly) added the risk percentages for each category together misrepresenting the facts.
If you look at the risk in each decade of life, the risk of breast cancer never exceeds 1 in 26 (4%).
Phew! That’s a big risk decrease.
It is true that risk increases with age, but it is not cumulative.
Furthermore, there is an additional glimmer of hope. Over 90% of women currently diagnosed with early stage breast cancer will be cured, and most will not require a mastectomy or chemotherapy.
Does HRT increase risk of breast cancer?
The famous statistic that hit the headlines from the WHI stated there was a 26% increase (relative risk of 1.26) in breast cancer in the HRT group compared to the placebo group.
This sounds scary!
Relative risk is the probability of an event happening in one group (in this case breast cancer developing in the HRT group) versus the risk of the event happening in the other group (in this case the placebo group).
Even though this increase is something to think about, many reporters act like it was a confirmed medical fact.
When the statistics were examined in more detail, this finding had not reached statistical significance.
When a finding does not reach statistical significance, that means that it is not a reliable and repeatable result.
Nonetheless, let’s look at the found relative risk and how that stands against other lifestyle behaviors.
For example, as shown in Table 1 below, HRT (i.e. Premarin/Progestin) has a lower relative risk for developing breast cancer than working the night shift (1.51), and lower than antibiotic use (2.07).
To really put it in perspective and to emphasize the importance of statistical significance, the last entry in the table - tobacco smoking and lung cancer is important to look at.
Tobacco smoking is a known cause of lung cancer and it has a statistical association that really means something, a 26.07 relative risk.
When this is compared to the 1.26 relative risk of HRT, the number is much less convincing.
What are other options for managing symptoms of menopause?
The symptoms of menopause include: hot flashes, night sweats, sleep problems, mood changes, vaginal dryness, decreased libido, dry skin, dry eyes, dry mouth, thinning hair, loss of breast fullness, weight gain, joint and muscle pain, memory and concentration issues, increased frequency of urination and bone density loss.
Wow. Writing that just feels so awful.
That’s a list of 15 symptoms of menopause.
HRT has been shown to ease all of those symptoms.
However, if you and your doctor feel that the risk is too high for you to take HRT, because you have a family history of breast cancer or have the BRAC1 or BRAC2 genes, there are alternative recommendations.
Most doctors first recommend lifestyle changes for managing menopause symptoms without HRT.
They recommend a healthy diet, exercise and stress management.
However for someone who is fit, healthy and not under stress, these recommendations can fall on deaf ears, especially if the woman is experiencing intense menopausal symptoms.
Some women try Complementary Alternative Medicine (CAM).
CAM includes vitamin E and herbal products like black cohosh, ginseng, dong quai, evening primrose oil and isoflavone from red clover.
Phytoestrogens are also recommended in CAM, these are naturally occurring plants that can mimic the effects of estrogen, such as soy products, flaxseeds and sesame seeds. Whole grains like oats, barley and wheat bran also contain phytoestrogen. Fruits like apples, cherries, beans and sprouts also have phytoestrogens.
Prescription medications have also been recommended to manage hot flashes, such as low-dose antidepressants, Gabapentin (originally developed to treat seizures) and Clonidine, a drug for high blood pressure.
Some women experience significant mood disturbances, anxiety and depression during the perimenopausal and postmenopausal periods and are often prescribed antidepressants.
It is also possible that given the promising data on psychedelics, like psilocybin and MDMA treating conditions like depression and anxiety in other contexts, that it’s theoretically possible they could be beneficial for some menopausal symptoms.
Is HRT right for me?
While the findings from the WHI study are now out of date and challenged by several medical professionals, the long lasting effects of the results are still present in the healthcare system.
Women today still report being unable to find a doctor who will write a prescription for HRT. So it may be difficult to understand if your doctor is withholding a prescription due to your personal risk, or because of unfounded concerns about using HRT.
I believe that if a woman wishes to start HRT, then routine monitoring and mammograms can be the preventative measures put in place by their doctor to screen for breast cancer developments and the therapy can be stopped at any sign of increased risk.
For the full scoop on Hormone Replacement Therapy and a serious takedown of the Women’s Health Initiative’s biostatisticians, I give you the…
📚 Book of the Week
Estrogen Matters: Why Taking Hormones in Menopause Can Improve Women's Well-Being and Lengthen Their Lives -- Without Raising the Risk of Breast Cancer by Avrum Bluming, M.D. and Carol Tavris, PhD
Dr. Bluming and Dr. Tavris debunk 16 year old claims against hormone replacement therapy (HRT) that scared physicians and women away from taking estrogen at the onset of menopause.
They present the latest clinical studies, evidence-based results, and evidence-informed results that are convincing for the health and wellness improvements that HRT can give women during this phase of life, and help bring clarity to the risks.
This book made me an HRT advocate and believer.
I highlighted the book like crazy and made my highlights visible on Goodreads, if you want the Cliff Notes version.
⚡️ Check This Out
Have you heard of the PET ROCK?
Did you own a PET ROCK as a kid?
They had a brief craze in 1975.
Believe it or not, PET ROCKS sold for $3.95 each.
The creator Gary Dahl sold a total of 1.5 million PET ROCKS in 6 months.
PET ROCK came with a Care and Training Guide which you can view online from the Internet Archive.
How would a child know how to take care of a PET ROCK without explicit instruction?!
The booklet explains that each pet rock has been evaluated for intelligence, and only the pet rocks which demonstrated a strong capacity for learning and obedience are allowed to wear the name PET ROCK.
The instructions feature obedience commands such as “come,” “stay,” “roll over” and “play dead” (“play dead” was one of the PET ROCK’s specialties).
There is also a section on attack training for both long distance and close range attacks.
I do have to give the creator some credit. He had a good sense of humor with the product, the guide, even his company name “Rock Bottom Productions.”
Edited by Wright Time Publishing