The Million woman study in the UK has shown an increase of ovarian cancer among women who used HRT more than 5 years

article here

Thousands of women swear by it and Absolutely Fabulous's Patsy made a sketch out of it.

And today they were told not to panic about results of a recent study on hormone replacement therapy.

An expert in the field said as long as HRT is used on a short-term basis, the risks are minimal.

He said some women may continue to use it past a five-year benchmark, but should seek specialist advice first.

A recent Million Women study found females who use HRT are more likely to be diagnosed with ovarian cancer and die of the disease.

The research showed an extra case of ovarian cancer is detected in every 2,500 women who take HRT - compared to those who don't - over a five-year period.

Hormone replacement therapy tends to be used by women with menopausal symptoms when their bodies produce less oestrogen.

It can help with problems such as hot flushes or headaches.

Although recent years have seen a sharp decline in its use, it is thought around one million women in the UK continue to use it.

Nearly 950,000 UK women were involved in the study, which also suggested a woman's risk of ovarian cancer returned to normal levels after stopping HRT for a few years.

However, Professor Philip Hannaford, a research director at the University of Aberdeen, today said women who use the treatment for less than five years are generally safe.

He said: "HRT is still useful for treating menopausal symptoms, although we do try to ask women not to use it to prevent diseases later in life.

"HRT is an effective and safe way of treating menopausal symptoms, although the important thing to remember is to use as low a dosage as possible for as short a time as possible."

He said anything under five years was thought of as short-term for using HRT.

Prof Hannaford pointed out that some women will end up using it longer than that.

He said: "If there is a reason to use it above five years you have to have a more informed discussion with your prescriber about it on an individual level."

The study's lead researcher, Professor Valerie Beral, said: "The results of this study are worrying because they show that not only does HRT increase the risk of getting ovarian cancer, it also increases a woman's risk of dying of ovarian cancer.

"This study, along with our previous research, clearly demonstrates the cancer risks of taking HRT."

The researchers, largely funded by Cancer Research UK, estimated the use of HRT since 1991 has resulted in an extra 1,300 cases and 1,000 deaths from ovarian cancer.

A Cancer Research spokeswoman said: "Women take HRT for different reasons and they have to discuss with their doctor whether they should take it or not."

But, this article suggests HRT may reduce the severity of breast cancer:

NEW YORK MAY 03, 2007 (Reuters Health) - Among patients with breast cancer, those with a history of hormone replacement therapy (HRT) appear to have a lower risk of distant metastases and lower mortality, according to German researchers.

In the April issue of the American Journal of Obstetrics and Gynecology, Dr. Florian Schuetz of University Hospital Heidelberg and colleagues point out that long-term HRT has been associated with an increased risk for developing breast cancer, but its influence on prognosis has rarely been examined.

To do so, the investigators analyzed data on 1072 patients aged 45-70 years at the time of first diagnosis of breast cancer. Of these, 793 were postmenopausal, and 320 of this group had received HRT for at least one year.

Follow-up for more than 6 years showed that tumor size and grading was significantly greater in the postmenopausal subjects who had not used HRT.

There were no between-group differences in local recurrences, but in the non-HRT group, there were significantly more metastases to bone (14.4% versus 6.2%), and to both the lung and the liver (9.9% versus 4.1%) than in the HRT group.

In addition, the death rate in the non-HRT group (21.1%) was significantly higher than in the HRT group (7.5%).

Speculating on the possible cause of this improved prognosis, the researchers suggest that normalized bone metabolism with HRT may deter tumor cell seeding. "The effect of decreased metastatic bone disease and increased survival in patients with pre-operative HRT," they write, "is due to the downregulation of increased bone turnover that is comparable to studies with bisphosphonates and other osteoprotective drugs."

Not all HRT is the same. I do recall that the risks of estrogen-only therapy are different than the risks of estrogen plus progesterone therapy. I haven't bothered to memorize which therapy increases what risks. Maybe Sheryl has? It's been all in the news the past few years.

Unfortunately all teh research has been done on the use of patent hormone replacement therapy which involves a synthetic progestin (provera etc) plus a form of horse estrogen....because this is what the pharm companies commercially manufacture, because they can't patent naturally occurring substances. I should add that the synthetic progestins look absolutely nothing like natural progesterone in their chemical composition and have a lot of unpleasant side effects. The only thing they have in common with natural progesterone is the effect of shedding the uterine lining to counteract the effect of the estrogen, which is what it is given for. But in all other respects these drugs are nothing at all like progesterone. Also, progesterone has other functions besudes just avoiding thickening of the uterine lining and some of the discomforts assocuiated with menopause are due more to decreased progesterone than to decreased estrogen, especially the tendency to mood problems and iritability (the hot flashes tho are estriogen).

Natural estrogen and natural progesterone are available and work very well in controlling menopausal symptoms. It is unfortunately not known if use of natural ("bioidentical") hormone replacement carries any of the risks noted with the use of the synthetics...and it may never be known because there's no money to be made in studying it, and the type of research required is costly and lengthy, since it involves measuring changes in small amounts of risk across large populations over many years.

So we are left in something of a pickle. It seems logical to expect that natural estrogen plus natural progesterone might be safer than the synthetic drugs have proven to be, they might even be safer than not taking hormone replacement at all -- but we don't know this as the research has not been done.

Personally I am taking HRT using only the natural products and in as small a dose as I can manage and still control the symptoms. To me, this is a sensible choice for anyone who finds that symptoms of menopause are affecting their quality of life, providing the do not have any gynecological problems or history of breast cancer that put them at special risk from estrogen. But in making this choice one has to keep in mind that the safety has not been established and that some increased risks have been documented with the synthetic drugs.

Those risks are not as great as the publicity may lead one to suspect and largely confined to longterm use rather than short term (e.g. couple of years) use just to get through the menopause.

In any event, if a woman does decide to take HRT it makes no sense at all to use the nasty synthetics, they have no advantage and many disadvantage over the natural forms. However most doctors are uninformed on this matter and don't even realize that synthetic progestins are not the same as progesterone and that the latter is available as an alternative.

Exceptions would be women with a hypersensitivity to progesterone and women with a condition for which estrogen is contraindicated. Such women would do well to try one of the new non-estrogen drugs which mimic estrogen in some of its effects.

Sheryls advice is spot on. How lucky we are to have such an empathic and knowledgable lady on this forum.

I too am taking natural (bioidentical) hormones, in the minimal possible to keep disruptive menopausal symptoms at bay. I hope not to have to take them too long.

Sheryl is also dead right about Ob/Gyns not even knowing about the difference between synthetic and natural hormones. I was prescribed a synthetic hormone by a (male) specialist at Bunrungrad but after only two doses felt quite ill. I stopped immediately.

Cant help feeling that if the menopause was something men had to endure, there would be much more information and it would be taken far more seriously. The baby boomer generations in the USA alone (some 70 million of them) are aging and many of them are facing the challenges of menopause. These generations tend to challenge the status quo and re-write the rules. It is through forums like this that many will become aware of all their options, thanks to people like Sheryl.

There is some really good (and different) info on the International Menopause Society website - just google for it. They seem to insinuate that the Million Women Study is scaremongering since the Report reports relative risks by percentage rather than absolute numbers. They state that in the Report the absolute risk for ovarian cancer was only one extra case per 2500 women after 5 years and mortality was one per 3300 over 5 years. Not exactly major is it?

A lot of good stuff on the website if anyone is interested.

Interesting site CC. I note they say that

"... there are no medical or scientific reasons to recommend unregistered bio-identical hormones. These "customised" hormonal preparations have not been tested in studies and their risks and impurities are unknown.

Safety data from studies from low-dose and ultra low dose regimens of estrogen and progesterone are encouraging"

From Page 184 (Pines et al) IMS Updated Recommendations. This is the link :

http://www.imsociety.org/PDF/IMS_Recommendations.pdf

Elsewhere they suggest the lowest possible doses should be used, which is precisely the regime suggested by Sheryl. Lowest possible, for the shortest time.

The natural estrogen products I am using are made by a pharmaceutical company in France. I use both Uterogestan (soft gelcaps) and natural Progestogel. These two products are difficult to get in Thailand simply because there is no demand for them. Fascino in Bangkok carry the gelcaps, but not the transdermal gel. The document quoted from above also says that the hormone absorbtion through skin is probably more effective, since it does not have to negotiate the liver.

The simple reason natural products have not been tested, as Sheryl says, is that natural chemicals cannot be patented, therefore the giant pharmaceutical companies cannot make big bucks from them.

That coupled with most (I suspect) Ob/Gyn's lack of knowledge of the availability of natural hormones, is the reason that natural hormones are not used.

It seems perfectly logical to me that if you use the minimum amount of a hormone which is chemically the same as your body would use, (rather than synthetics which are not), detrimental side effects can be minimised, and disruptive, unpleasant and disturbing menopausal symptoms may be diminished, or at the very least, reduced to a bearable level.

The natural estrogen products I am using are made by a pharmaceutical company in France. I use both Uterogestan (soft gelcaps) and natural Progestogel. These two products are difficult to get in Thailand simply because there is no demand for them. Fascino in Bangkok carry the gelcaps, but not the transdermal gel. The document quoted from above also says that the hormone absorbtion through skin is probably more effective, since it does not have to negotiate the liver.

I am using limited amounts of oestrogel, that I get from my pharmacist in BKK. Isn't it made by the same company that makes progestogel? Laboratories Besins in France. I'm currently not using enough to ease my symtoms as I was concerned about the risk of breast cancer. No history in my family, just history of fibrocystic breasts. I've had two biopsis because of calcifications. all negative.

I really need something to ease my symptoms. My grandmother continued to have hotflashes into her 80's so for them letting up....I'm still waiting. My Aunt is 65 and still waiting. I'd appreciate any suggestions of alternatives available here.

I know when I go to the doctor that they will prescribe is premarin, which seems to be readily available here. I never took it in the states and I'm not about to start now. They also don't seem to have any vaginal estrogen therapy here to my knowledge except for the premarin cream.

Thanks,

Beachbunny

My step mother has had breast cancer 3 times. The first time she had it, she was on hormones after a radical hysterectom. As soon as she was diagnosed with breast cancer they immediately took her off the hormones. This was in 1981 and tells me that doctors have long known there must be some kind of link between hormones and breast cancer.

The natural hormone therapy makes more sense to me, as does using the minimum. Especially if you have a history of cancer in your family. I suspect, if they researched the women's medical histories in the study they would find the women who were diagnosed with cancer had a history of it in their family.

After watching my step mother diagnosed with breast cancer 3 times, her brother die of cancer as well as her uncle, I am convinced there is a genetic element. Anyone with a history of cancer should most likely just suffer through menopause. If she were my biological mother you bet I would.

Beachbunny --- I too started using Estrogel after reading on the net somewhere that it helps with menopausal symptoms. What I did not realise is that women with wombs need to shed the lining every month, and progesogel apparently does that. It is Estrogel which causes the lining to build up. It is my understanding that endometrial cancer can result if it is not shed.

Yes, the Progestogel is made by the same company, Besins in France, as the Estrogel, but it is not available in Thailand, due to lack of demand. It is (or rather was) listed in Mimms but the importer is not (they say) importing any more. However, you can get Uterogestin in soft gelcaps, from Fascino in Bkk (the big one opposite the royal hospital), and sometimes in Pattaya. They are orally administered, and I take two at night (they can make you sleepy), in combination with the minimum of Estrogel I can get away with. Estrogel seems readily available from most pharmacists.

Best advice I believe is to use the minimum possible to control troublesome symptoms (mine including insatiable itching, hot flushes and total insomnia), but of course, this varies from person to person.

I only know all of this because of Sheryl --- there was a thread awhile back which explains all! I found it very complicated, but interesting. Sheryl definitely knows much more about it than at least two out of the three Ob/Gyns I went to three different hospitals, two of them in Bangkok.

Again thanks to Sheryl, I now have the absolutely best Ob/Gyn -- US board certified even. And a Doctor who actually listens and reacts.

SBK -- your poor step mum. How absolutely terrifying for her and what a brave lady. But was she taking the synthetic hormones, which are altered at the molecular level so that pharmaceutical companies may patent them, or the natural hormones, which are the same precisely as your own body makes? Anything 'foreign' to the body's own chemicals must have an effect, it seems logical.

I agree with you on cancer often being hereditary. I know that it is proven some are, like bowel cancer, but I do not know about breast cancer. I know a lady in Eire who was kicked in the breast (accidentally) by a horse. She swore that was the reason for the breast cancer, which sadly led to her death three years later.

I believe that with increased age comes increased risk of all types of cancer, but again, I am not sure and stand to be corrected.

Breast cancer can be hereditary. And my mom is the toughest person I know. I admire her greatly

No idea as to what hormones she was one, this would have been late 70's early 80's. So, the dose was high, to be sure. But my main point was that they must have had some clue as to the relationship between hormones and breast cancer even back then, or they wouldnt' have yanked her off the hormones immediately. She went through instant and total menopause. IE She went from a high hormone level to zero, her menopause was very strong and awful, but she used alot of natural remedies, and just toughed through it. Obviously not everyone needs to do this, but I strongly suggest anyone with a history of cancer in their family to consider it.

Beachbunny,

As EFL said, you should not take estrogen along, as it will cause thickening of the uterine lining. Need to take progesterone with it. Avoid the synthetic progestins like the plague, they have a lot of side effects (and may well be responsible for the risks identified in the Nurses health study (famous one on HRT), although we can't say because there was no comparison group taking natural progesterone.

in Thailand the only form of natural progesesterone available is Utrogestan. If you go to Cambodia, or Europe, you can get Progestogel (same manufacturer as Estrogel).

Progesterone is a precursor to estrogen so adding it may avert the need to increase your estrogen dose. Altho if the problem is hot flashes, you may still need to use more estrogen. A vaginal estrogen cream would not help much with that anyhow as effect is mostly local.

In terms of estrogen preparations available in Thailand, besides oestregel there is a patch called Estraderm.

regarding breast cancer: Fibrocystic breast disease does not necessarily mean an increased risk. It really depends on the exact nature of the cysts. In fact "fibrocystic" is used to describe a wide range of benign breast conditions to the extent that the term doesn't really mean much. If the cysts you had showed atypical hyperplasia (would be in the biopsy result) then yes, you are at greater than average risk. If no atypical hyperplasia, but ductal proliferation, there is a slight increased risk. Otherwise, no increased risk.

Evidence to date does not suggest a significant increase in breast cancer with short-term use of estrogen replacement. And, of course, there have been no studies at all on replacement using natural estrogen.

The reason women with breast cancer often have to stop taking estrogen (or, if they are pre-menopausal, may have to take drugs that block estrogen) is that some breast cancers -- some, not all -- are estrogen-dependent and grow much more aggressively when estrogen is present. That does not mean they were caused by estrogen, just that they grow best in the presence of estrogen. If estrogen per se caused breast cancer, the rates of it in younger pre-menopausal women would be much, much higher than is the case.

It would be more accurate to say that menopause confers some protection against estrogen-dependent breast cancers and that this protection is reduced if estrogen replacement is taken. On the other hand, you also lacked this protection prior to menopause when your body had naturally high levels of estrogen.

I have researched this issue for years and came to the conclusion that, unless one has a specific history of breast or ovarian cancer in oneself or a first degree relative, or other known medical conditions that contraindicate it, it is impossible to make the decision for or against hormone replacement on health grounds alone and boils down to a quality of life issue.

Until I experienced it, I rather thought I'd tough out the menopause without estrogen replacement (I've been using natural progesterone tho for years for PMS). HAH!!! Didn't take too many sleepless nights and sweat-soaked bedsheets to change my mind.

I have cystic breasts, I use estrogel, but I do make sure to have yearly mammograms now whereas before starting the estrogel I would have them maybe every 3 years.

From what you say, it would not be unreasonable for you to increase your dose of estrogen to the least amount at which you are comfortable, as long as you add progesterone, provided your biopsies didn't show atypical hyperplasia or ductal proliferation. That's not to say there is no chance you'll get breast cancer; of course there is...even if you don't use estrogen.

Bottom line, every woman has to make her own informed decision. I think a lot boils down to how uncomfortable your symptoms are making you and how much you value the quality of life at present versus ensuring the lowest possible risk of future threats. Some women are willing to suffer for years on the remote chance of a very small statistical reduction in risk of future disease; others aren't.

Bottom line, every woman has to make her own informed decision. I think a lot boils down to how uncomfortable your symptoms are making you and how much you value the quality of life at present versus ensuring the lowest possible risk of future threats. Some women are willing to suffer for years on the remote chance of a very small statistical reduction in risk of future disease; others aren't.

Sheryl & EFL,

Thanks for taking the time to give such detailed replies.

I did fail to mention I had my uterus removed around age 48/49 due to massive fibroids. I sill have my ovaries whiched helped for a couple of years. My U.S. doctor prescribed 2mg of estrace because 1mg gave me now relief at all and 2 mg still left me with some hotflashes. She told me from my blood tests that I just wasn't absorbing it. Now I think I may have had less absorption using the pill form. She recommended the patch, but I have a severe allergy to ANY type of adhesive or latex products.

I had a friend recommend soy...........well I've been down that route. Found out if you have a thyroid problem like I do you shouldn't be taking any soy supplements. Black Cohosh made me ill..............................

I totally agree with you that it has to be your decision and your quality of life. You can not say you will never use hormones until you yourself experience it. Some people are fortunate and never have any symptoms, and other only mild symptoms. Mine seem to be on the extreme end of the spectrum. Starts with nausea and/or anxiety travels up my chest to my neck and face. Sometimes I'll have one right after the other. I made the mistake of trying to quite estrogen totally and found out that I was so miserable and irritable I didn't want to live with me. I also have my night sweats during the day and not the night....not fun being out somewhere and totally soaking wet from sweat.

I have no history on my mother's side of any breast or uterine cancer. My mother did pass away from large cell sarcoma at age 64, and my grandmother at age 93 from they assume cancer from a kidney tumor she had removed 11 years prior to her death. At her age she didn't want any exploratory surgery.

For me right now in Thailand with the limited medications available I think the oestrogel is the best bet.

By the way I have a medical reason for requiring vaginal estrogen, I realize it doesn't help with the hotflashes that it only helps locally. If anyone knows where I can get a estridiol/estrace vaginal cream or tablets near Sattahip/Pattaya area I would appreciate the information.

Beachbunny

If you have had your uterus removed, it is safe not to take progesterone but it may still provide more relief if you do. Suggest you try it. Altho the hot flashes are pretty specific to estrogen, the other things (anxiety etc) can also result from low progesterone. If I were you I'd buy a pack of utrogestan and try it, you'll know pretty quickly if it is helping. As far as is known it is without side effects or dangers other than making some people a bit sleepy after taking it, or in people who are allergic to it.

I believe there is a Fascino's in Pattya, which would be your best bet for a pharmacy They usually have just about everything licensed for sale in Thailand.

A pill form of estradiol is going to have the same action as the oestrogel. If dryness is the problem you need a topical product. I checked and there is one (only one!) avialable in Thailand, it's a controlled release vaginal tablet called Vagifem. Made by Novo Nordisk.

Good luck and hang in there. I know EXACTLY what you're going through!!

If you have had your uterus removed, it is safe not to take progesterone but it may still provide more relief if you do. Suggest you try it. Altho the hot flashes are pretty specific to estrogen, the other things (anxiety etc) can also result from low progesterone. If I were you I'd buy a pack of utrogestan and try it, you'll know pretty quickly if it is helping. As far as is known it is without side effects or dangers other than making some people a bit sleepy after taking it, or in people who are allergic to it.

I believe there is a Fascino's in Pattya, which would be your best bet for a pharmacy They usually have just about everything licensed for sale in Thailand.

A pill form of estradiol is going to have the same action as the oestrogel. If dryness is the problem you need a topical product. I checked and there is one (only one!) avialable in Thailand, it's a controlled release vaginal tablet called Vagifem. Made by Novo Nordisk.

Good luck and hang in there. I know EXACTLY what you're going through!!

Thanks for the reply Sheryl.

It would be great that vagifem is available here now. I contacted Novo Nordisk last fall and they told me it wasn't available here. Would be really glad if it is. tablets much less messy!

I don't wish my misery on anyone, but it's kind of nice to know that someone KNOWS exactly what I'm going through.

Beachbunny

Beach bunny - Sheryl is right, there is a HUGE Fascino in Pattaya, it is a large building, set back from the road, with an in and and out driveway. It is just before Tesco/Lotus, on the opposite side of the road --- sorry, North Road.

As well as carrying just about everything medical one could hope for, they are just about the only one in Patttaya who sell Utrogestan. I only know this as I dragged my husband to just about every pharmacy in or near Pattaya.

Ask for a discount card, and they will knock about 10% off (I think). The soft gelcaps work quickly, and you will soon know if they are making a difference. I noticed after the second dose. Took one in the morning, and one in the evening. But then two at night as they made me sleepy. This is the only side effect I noticed, apart from not having the dreading hot flashes.

Best of luck Beachbunny, severe symptoms which impact both your life, and those of your family, are not fun at all. Best of luck!