“We shouldn’t be scared of hormones.”
Such a hot topic for this month! October is Breast Cancer Awareness month and with so much controversy and contradicting information surrounding HRT and breast cancer this talk was seriously popular!
Dr Macbeth says “HRT is literally just trying to kind of smooth out those significant swings that you get in the menopause.” Dr Alison Macbeth is a British Menopause Society accredited GP with a passion for women’s health.
The session cleverly dealt with the elephant in the room first, and got straight to the point.
Does HRT cause breast cancer?
This is such an important question. Because this is the myth of all the myths that has truly STUCK!
But, there is just so much fear surrounding HRT and oestrogen. And if you ask anyone off the street and even most breast cancer surgeons, or physicians, they will automatically think breast cancer as soon as you mention HRT.
So, all this fear is stemming from the big US trial plastered all over the newspapers 20 years ago! The front pages read, “HRT gives you breast cancer!”
Overnight women stopped their HRT. However, there were numerous problems with the trials, amongst them were that women in the trials were aged around 63 and they were obese... then they were also using old fashioned synthetic oestrogen and often much higher doses of synthetic progesterone. So, what we try and do now is use body identical HRT, which is as close as possible to what the body is naturally producing. So, you can get it as a tablet, gel, cream, patch or spray. So, essentially what those trials showed was that women over the age of 65 did have an increased risk of breast cancer and heart disease...but that's because they were older and obese, and so they already had the risk factors for breast cancer and heart disease and stroke. For women under the age of 60 specifically, it showed that if you were on oestrogen only HRT you had a lower risk of breast cancer than women who'd never used HRT.
Not all HRT is the same and the new style of HRT is meant to be safer; and it's actually really important to say that HRT doesn't cause breast cancer.
What we do know is that HRT reduces risks of:
Heart disease
Osteoporosis
Colon cancer
Type 2 diabetes
So, the benefits outweigh the risks, and it's just trying to put it all into some sort of context.
Dr Macbeth says “It’s just oestrogen. I don't know why people are so worried about oestrogen and progesterone. We produce it in our bodies and, we dish out buckets full of birth control pill, and people aren't terrified of the birth control pill. But the birth control pill is probably the same or even slightly higher risk – it’s old-fashioned high dose synthetic oestrogen and synthetic progesterone. So, if we're going to be scared about HRT, you could argue we actually should be just as scared of the pill! But again, the risks are so low with the pill, we shouldn't be scared. Women need contraception, and we shouldn't be scared of hormones. We shouldn't be scared of the pill. And we absolutely shouldn't be scared of HRT.”
Now, the million-dollar question is if you’ve had breast cancer can you take HRT?
If you are diagnosed with breast cancer now, you have an over 90% survival rate and if you're diagnosed with early-stage breast cancer, you've got about 99% survival rate, so we know that there's millions of women in the world right now that are post-menopausal with breast cancer; and the guidelines state that HRT is contraindicated.
The fear is, if you've got some kind of dormant breast cancer cells that are sleeping, and you give them oestrogen. It can wake them up and make your breast cancer spread.
But, it's not all about breast risk, it’s about heart risk and it's about osteoporosis risk as well. So, the medical community are very risk averse, and the current guidelines are all based essentially on the Swedish ‘Habits’ trial, which again used the old synthetic form of HRT. So, all we can say is we simply just don't know the risk, but it doesn't look like the risk is significant at all.
So, in answer to that question, Dr Macbeth said yes, you can but quite rightly it's not a five-minute conversation with your GP.
Breast cancer is the most common female cancer there is. One in seven women is going to get breast cancer, and the risks are:
Essentially being female
Increasing age
Poor diet
Poor lifestyle
Obesity
Alcohol
Breast density
Genetics
….and just pure bad luck!
From listening to this session, it sounds like every single woman with breast cancer is going to have a different journey and a different story; and even if you've got somebody with exactly the same cancer as somebody else, they're going to have different risks and different benefits of giving them HRT.
It's weighing up these risks and the benefits, because the concern is if you've got hormone receptor positive breast cancer, you're using medication to block oestrogen. So, it doesn’t make any sense to give oestrogen back as HRT; and that's what all the breast surgeons and the oncologists are looking at; and that's what everyone's fear is.
Dr Macbeth finishes up by saying “it’s important to remember, the biggest killer of post-menopausal women is heart disease, followed by osteoporosis, dementia, stroke and COPD. Breast cancer is way, way down in that list. So, you know, it really really is weighing up the risks and the benefits.”
To watch Dr Macbeth’s talk again, head here – it’s enlightening!
Next week - What’s your gut got to do with it?
Join us for an insightful and educational session to find out just how important your gut health is, especially during peri/menopause. We are joined for this partner session by Joanna Lyall, who is the co-founder of Better Menopause and is also a certified nutritional therapist. We will find out exactly what you gut has to do with it and more to the point how we can help our symptoms. Tuesday, October 31st at 1.15pm. You can subscribe here – well worth tuning in for!
Written by Anila Shyam, October 2023