Oct
05
2019

Breast Cancer Risk Persists After Hormone Replacement Therapy

By | blood test, breast cancer, Cancer, Hormones, Menopause, Osteoporosis

New research showed that the breast cancer risk persists after hormone replacement therapy (HRT). This is described in this CNN article. It is common knowledge for some time that female patients who use synthetic hormones as hormone replacement in menopause, have a 1.6-fold to 1.8-fold risk to develop breast cancer. However, since the abrupt ending of the Women’s Health Initiative (WHI) in 2002 the truth about the risks of HRT became known and made HRT more confusing. After all, in this trial they wanted to show once and for all that HRT would be beneficial. The expectation was that HRT would prevent osteoporosis, heart attacks and breast cancer. But the results were quite different. Instead the study found a 41% increase in strokes, 29% increase in heart attacks, 26% increase in breast cancer, 22% increase in total cardiovascular disease and a doubling in the risk for blood clots.

Missing information about synthetic hormones

What the authors of the study did not explain was the fact that it was the properties of the synthetic hormones, progestagen and Premarin, that were responsible for the negative effects. Had researchers insisted to perform the study with bioidentical hormones, the results would have been quite the opposite! With bioidentical hormone replacement we see the prevention of heart attacks and clots; cancer rates are lower than controls, and the prevention of osteoporosis is another benefit. The end result is a reduction in mortality rates. These horrifying results from the use of synthetic hormones still frighten many women. This is particularly so when it comes to replacing hormones after menopause.

Breast cancer risk study with HRT in more details

The research study described in the CNN article is based on a more comprehensive Lancet study. The researchers did a Meta analysis of 58 prospective studies. Unfortunately all the hormones given were synthetic hormones (not bioidentical ones) that had the same configuration as in the WHI. On average women became menopausal at age 50. This is when the physicians commenced HRT. The prospective follow-up showed that 108,647 postmenopausal women developed breast cancer around the age of 65. 55,575 women (51%) had used HRT. Postmenopausal women who used estrogen/progestagen combinations during years 1–4 had a relative risk of 1.60-fold to develop breast cancer. This risk increased during years 5–14 after exposure to estrogen/progestagen with a relative risk of 2.08-fold to develop breast cancer. 

More details about breast cancer risks

The risk of developing breast cancer was lower when women took estrogen only as a form of HRT. For years 1-4 the relative breast cancer risk for patients on estrogen alone was only 1.17-fold. Regarding years 5-14 with estrogen-alone replacement the breast cancer risk was 1.33-fold.

Women of average weight who started their HRT of estrogen/progestagen pills at age 50 with menopause one woman in 50 users developed breast cancer between the ages of 50 and 69. In women who used estrogen regularly, but progestagen only irregularly, one in 70 users developed breast cancer. For estrogen only users one in every 200 women developed breast cancer.

Discussion of the above results

Dr. Wright and Dr. John Lee have pointed out years ago that there are alternatives to taking synthetic hormones as HRT. Taking oral synthetic hormone preparations is problematical. First, the pharmaceutical company attached chemical side chains to the synthetic hormones. The women’s estrogen receptors recognize the synthetic hormones only partially. Hormone researchers developed progestagen to mimic a woman’s progesterone. But it turns out that the estrogen receptors read progestagens like an estrogen. This is the reason why there are higher breast cancer rates with the combination of estrogen/progestagen than estrogen alone. Secondly, there is a problem of estrogen dominance, which causes a higher likelihood that the patient develops breast cancer or heart attacks.

Avoiding estrogen dominance reduces breast cancer risk

If estrogen is balanced with progesterone, the cancer promoting effect of estrogen is counterbalanced, and the women on bioidentical hormone replacement are protected from the serious side effects women of the WHI had to endure.

Bioidentical estrogen applications are available through creams that women apply to the skin. This avoids the problem of the first-pass effect; if estrogens are absorbed from a pill in the gut they have to pass through the liver, which is the organ that metabolizes them.

Bioidentical hormone replacement as an alternative to HRT

In Europe there has been a strong resistance to using synthetic hormones. As a result long-term studies were able to show that there is no danger when bioidentical hormone replacements therapy uses creams that are applied to the skin or intravaginally. This avoids the first-pass effect in the liver, as is the case with synthetic estrogens and progestagens taken orally as pills.

John Lee stated that physicians should measure hormones and identify those women who are truly hormone deficient. These are the ones who need hormone replacement. However, physicians should use only bioidentical hormones in a hormone replacement therapy. And they should also replace only as much as necessary to normalize the hormone levels. This is also the level where postmenopausal symptoms disappear. Dr. Lee noted: “A 10-year French study of HRT using a low-dose estradiol patch plus oral progesterone shows no increased risk of breast cancer, strokes or heart attacks”.

How is bioidentical hormone replacement done?

The best method is usually a bioidentical hormone cream application to the forearms or to the chest wall once per day. A woman on bioidentical hormone replacement applies bioidentical Bi-Est cream and progesterone cream to the skin of her forearms or chest wall. The hormones get directly absorbed into the blood stream and can do their job without interference. The treating physician can prescribe different amounts of the bioidentical hormones depending on saliva tests or blood tests. 1 or 2 months later repeat blood or saliva tests can follow to verify that the amounts of the replacement hormones and their absorption are adequate for the patient’s need.

Difficulties to measure progesterone levels

Dr. David Zava, PhD gave a talk on breast cancer risks. This was a presentation at the 24th Annual World Congress on Anti-Aging Medicine (Dec. 9-11, 2016) in Las Vegas that I attended. Dr. Zava, who runs the ZRT laboratory, spent some time to explain how to measure progesterone in a physiological way.

Blood (serum) progesterone levels do not adequately reflect what the hormone tissue level is like in a woman’s breasts. On the other hand saliva hormone levels are giving an accurate account of what breast tissue levels are like.

Progesterone blood levels versus progesterone tissues levels

Dr. Zava gave an example of a woman who received an application of 30 mg of topical progesterone. Next, laboratory tests observed hourly progesterone levels in serum and saliva. The serum progesterone levels remained at around 2 ng/ml, while the saliva progesterone levels peaked 3 to 5 hours after the application. It reached 16 ng/ml in saliva, which also represents the breast tissue progesterone level. Dr. Zava said that the important lesson to learn from this is not to trust blood progesterone levels. Too many physicians fall into this trap and order too much progesterone cream based on a misleading low blood test. This leads to overdosing progesterone. With salivary progesterone levels it is possible to see the physiological tissue levels, which is impossible with blood tests. Dr. Zava emphasized that testing blood or urine as progesterone hormone tests will underestimate bio-potency and lead to overdosing the patient.

Breast Cancer Risk Persists After Hormone Replacement Therapy

Breast Cancer Risk Persists After Hormone Replacement Therapy

Conclusion

A new Meta analysis of 58 prospective studies with a large amount of participants showed that standard hormone replacement therapy (HRT) for postmenopausal women causes breast cancer. Postmenopausal women who used estrogen/progestagen combinations during years 1–4 after menopause had a relative risk of 1.60-fold to develop breast cancer. This risk increased during years 5–14 after exposure to estrogen/progestagen with a relative risk of 2.08-fold to develop breast cancer. Unfortunately all of the patients had received the standard Premarin estrogen and synthetic progestagen combination. The body’s estrogen receptors read both of these synthetic hormones as estrogen, which led to estrogen dominance. Estrogen dominance (with missing natural progesterone) is known to cause breast cancer.

Comments and discussion of bioidentical hormone replacement (BHRT)

I have explained in my comment that the investigators should have used bioidentical hormone replacement therapy (BHRT) instead of making a similar mistake as in the Women’s Health Initiative, where synthetic hormones caused cancer, heart attacks and blood clots.

Bioidentical hormone replacement is started with progesterone creams first in order to avoid estrogen dominance. After hormone tests estrogen is gradually introduced as Bi-Est cream applied to the skin and balanced with the progesterone. The physician orders blood estrogen levels and progesterone saliva hormone tests from time to time to monitor the hormone levels. No cancer occurs with bioidentical hormone replacement. It also protects from osteoporosis, heart attacks and strokes.

Part of this blog was published here before.

Oct
21
2017

Bioidentical Hormone Replacement

By | breast cancer, heart attack, Hormones, Menopause, Mortality, Osteoporosis, Stroke

Recently Medical News Today published an article on bioidentical hormone replacement in the Sept. 19, 2017 edition.

Although it was partially informative, I felt that there was an underlying bias against the use of bioidentical hormone replacement. The article made it sound as if hormone replacement therapy would not be safe. But the opposite is true with bioidentical hormone replacement.

Why are many women afraid of bioidentical hormone replacement?

At the time when there was a lot of confusion about hormone replacement therapy (HRT) the results of the Women’s Health Initiative (WHI) made it even more confusing. After all there was one trial to show once and for all that HRT would be beneficial. The expectation was that HRT prevents osteoporosis, heart attacks and breast cancer. But the results were quite different. Instead the study found a 41% increase in strokes, 29% increase in heart attacks, 26% increase in breast cancer, 22% increase in total cardiovascular disease and a doubling in the risk for blood clots.

Missing information about synthetic hormones

What the authors of the study did not explain was the fact that it was the properties of the synthetic hormones, progestin and Premarin were responsible for the negative effects. Had research insisted to perform the study with bioidentical hormones, the results would have been quite the opposite! With bioidentical hormone replacement we see the prevention of heart attacks and clots; cancer rates are lower than controls, and the prevention of osteoporosis is another benefit. The end result is a reduction in mortality rates. But the horrifying results that are due to the use of synthetic hormones and that the WHI warned about linger on in the minds of many women.

The use of bioidentical hormone replacement

Dr. John Lee pointed out in several of his books that the physician should only replace hormone loss with bioidentical hormones. He also pointed out that physicians should only replace those hormones that are at low levels or missing. This means that the woman should have confirmatory blood tests like FSH, LH, blood estrogen and salivary progesterone. If estrogen and progesterone are missing, the physician usually starts the woman on progesterone cream first. After two months, when laboratory tests show a saturation with progesterone , the addition of estrogen can follow, typically as the Bi-Est cream. This is a mix of estriol and estradiol.

Caution to balance against estrogen dominance

Progesterone is started first to balance against the potential cancer-inducing effect of estradiol. With the addition of progesterone a balance is the result, and estrogen will not cause breast cancer. This is also why Bi-Est is used: it is a mix of estriol and estradiol. Estriol is neutral with regard to causing breast cancer. Estradiol is the main natural estrogen in a woman, so some of it is necessary to make the woman feel normal. This is how the body receptors are functioning. But estradiol alone, when not in balance with progesterone, can cause breast cancer and uterine cancer.

The key is that only women who need bioidentical hormones should receive it. There are some women whose blood tests do not show a lack of estrogen, but only a lack of progesterone. These women should receive replacement with bioidentical progesterone to re-establish the hormone balance between estradiol and progesterone.

Safety of bioidentical hormone replacement products

As I have mentioned before, the Women’s Health Initiative in 2002 showed that on Premarin and progestin, two synthetic hormone products women came down with breast cancer, heart attacks, stroke, and thromboembolic events. They were using the synthetic drugs, namely conjugated equine estrogen and medroxyprogesterone acetate. The reason these women had to suffer these side effects was because their physicians insisted in using “pure hormones that a drug company had manufactured”. But these synthetic hormones were not pure hormones; they were adulterated with side chains so that pharmaceutical companies could patent them. These side chains made the synthetic hormones not fit the body’s hormone receptors. And this is the reason why the synthetic hormones created chaos in form of breast cancer, strokes and heart attacks.

Women’s Health Initiative authors whitewashed study results

Instead of admitting their mistakes, the full truth never became public. Instead the authors of the WHI study stated that it would be necessary to limit hormone replacement in menopause to the minimum amount of synthetic hormones to control symptoms, and their use should not exceed more than 5 years. These authors never distinguished between bioidentical hormones that fit the body’s hormone receptors and the synthetic hormones that irritated or blocked the body’s hormone receptors. There are thousands of women in Europe who have been on bioidentical hormones for decades, and they are doing just fine!

Bioidentical hormones in balance have no side effects

The truth is that bioidentical hormones –as long as they are kept in balance-do not have any side effects. Bioidentical hormones are the same that a woman produces in her ovaries before menopause sets in. The production of her bioidentical hormones kept her healthy. But the treating physician needs to carefully watch the balance of the hormones in the woman who is replaced with bioidentical estrogen and progesterone. This means that she needs to get enough progesterone to counterbalance estrogen stimulation. Hormones are constantly changing and if you don’t measure them, you don’t know what you are dealing with.

Dr. Lee said to measure hormone levels

John Lee showed a long time ago that you should measure hormones and identify those women who are truly hormone deficient. These are the ones who need hormone replacement. However, physicians should use only bioidentical hormones to replace what is missing. And they should also replace only as much as necessary to normalize the levels. This is also the level where postmenopausal symptoms disappear. Dr. Lee noted: “A 10-year French study of HRT using a low-dose estradiol patch plus oral progesterone shows no increased risk of breast cancer, strokes or heart attacks”.

How is bioidentical hormone replacement done?

The best method is usually a bioidentical hormone cream application to the forearms or to the chest wall once per day. This avoids the first-pass metabolism where the hormones, if absorbed from a pill in the gut have to pass through the liver. Part of the hormones can get metabolized and some of the hormone effect may disappear. By applying bioidentical Bi-Est cream and progesterone cream to the skin, the hormones get directly absorbed into the blood stream and can do their job without interference. The treating physician can prescribe different amounts of the bioidentical hormones depending on saliva tests or blood tests. 1 or 2 months later repeat blood or saliva tests can follow to verify that the amounts of the replacement hormones and their absorption are adequate for the patient’s need.

What are the side effects of bioidentical hormone replacement?

Normally, when estrogen and progesterone are in balance, there should be no side effect. However, in the beginning of replacement therapy sometimes one of the hormones gets too high. If this happens with estrogen replacement, the woman becomes estrogen-dominant. She would experience symptoms of bloating, fatigue, weight gain, depression, headaches, loss of sex drive. She can also develop uterine fibroids, endometriosis and hypothyroidism. It was Dr. John Lee who first described this (Ref.1). There can also be mood swings, craving for sweets, irritability, and sluggishness in the morning. The key is to cut back on the estrogen dosage; alternatively, if progesterone is low in saliva tests, this hormone may need an increase, which would rebalance estrogen. At the end of fine-tuning of bioidentical hormone replacement the woman will feel normal and have no negative side effects, but the process of fine-tuning may take several months.

Difficulties to measure progesterone levels

Dr. David Zava, PhD gave a talk on breast cancer risks. This was a presentation at the 24th Annual World Congress on Anti-Aging Medicine (Dec. 9-11, 2016) in Las Vegas that I attended. Dr. Zava, who runs the ZRT laboratory spent some time to explain how to measure progesterone in a physiological way.

Blood (serum) progesterone levels do not adequately reflect what the hormone tissue level is like in a woman’s breasts. On the other hand saliva hormone levels are giving an accurate account of what breast tissue levels are like.

Progesterone blood levels versus progesterone tissues levels

Dr. Zava gave an example of a woman who received an application of 30 mg of topical progesterone. Next, laboratory tests observed hourly progesterone levels in the serum and in the saliva. The serum progesterone levels remained at around 2 ng/ml, while the saliva progesterone levels peaked 3 to 5 hours after the application. It reached 16 ng/ml in saliva, which also represents the breast tissue progesterone level. Dr. Zava said that the important lesson to learn from this is not to trust blood progesterone levels. Too many physicians fall into this trap and order too much progesterone cream based on a misleading blood test. This leads to overdosing progesterone. With salivary progesterone levels you see the physiological tissue levels, with blood tests you don’t. Dr. Zava emphasized that testing blood or urine as progesterone hormone tests will underestimate bio-potency and lead to overdosing the patient.

Bioidentical Hormone Replacement

Bioidentical Hormone Replacement

Conclusion

Bioidentical hormone replacement, properly done, does not cause cancer, does not cause blood clots and prevents heart attacks and strokes. It also prevents osteoporosis and the associated fractures in older women. The key is that the natural hormones fit the body’s own hormone receptors. The reason why menopausal symptoms appear is that natural hormones (estrogen and progesterone) are missing. Physicians treated patients with synthetic hormones during the Women’s Health Initiative. In contrast, hormone replacement for missing hormones in a menopausal woman with bioidentical hormones  has no side effect. Contrary to the Women’s Health Initiative in 2002 there are no breast cancers, no heart attacks and no strokes with bioidentical hormone replacement. What is even better is that these women will live without all the postmenopausal problems, and their life expectancy will be about 10 years longer than without bioidentical hormone replacement.

References

Ref. 1. Dr. John R. Lee: “What your doctor may not tell you about menopause: the breakthrough book on natural hormone balance”. Sept. 2004.

Incoming search terms:

Aug
01
2006

Non-Hormone Alternative Against Hot Flashes

By | Hormones, Women’s Diseases

Hormone replacement therapy has its positive and negative effects, and the proven risk of breast cancer has stopped many women from choosing hormone replacement for menopausal problems. Yet menopausal problems can be a source of suffering and frustration for those women who are affected. Menopausal hot flashes can be bothersome, and if they are severe, frequent and go on for years, women find it difficult to cope with this condition. Even if hormone replacement is not an option because of the risk factors, relief of those symptoms is very much needed. Herbal remedies are often not sufficient. As a result the day to day functioning of the patient is affected and even a restful night is interrupted by sweating.
Dr. Sireesha Reddy from the department of obstetrics and gynecology at the University of Rochester’s school of medicine and dentistry has led a study of 60 postmenopausal women. A medication called gabapentin was used in a randomized study. Three equal groups were observed: the first received gabapentin titrated to 2,400 mg per day. The second group received 0.625 mg per day of estrogen, and the third group was given a placebo. The gabapentin group and the estrogen group achieved similar results, namely a 71% reduction, versus 72% in the estrogen group. The placebo group reported a 54 % reduction of hot flashes.
Dr. Reddy states that gabapentin against hot flashes is a good alternative. It works for patients who only have these particular problems, as it does not address other indications where estrogen is prescribed.

Non-Hormone Alternative Against Hot Flashes

Non-Hormone Alternative Against Hot Flashes

Dr. Reddy also added that it might not be necessary to titrate to 2,400 mg gabapentin per day, because some women metabolize it at a higher rate than others.
Specific side effects such as headaches and dizziness occurred more frequently in the gabapentin group, but they were not statistically significant.

Reference: The Medical Post, July 18, 2006, page 4

Comment on Nov. 13, 2012: This is an example of symptomatic therapy for one symptom, in this case hot flashes, but the trade-off are side effects like headaches and dizziness, which were discussed away because they were “statistically not significant”. Women in menopause have a lack of estrogen and progesterone, which is sensed by the receptors for both of these hormones throughout the woman’s body. The solution is bio-identical hormone replacement with specific hormone measurements as discussed under this link.

Last edited December 6, 2012

Apr
01
2005

Hormone Replacement Worsens Incontinence

By | Hormones, Prevention, Women’s Diseases

Once hailed as the miracle pill for the aging woman, hormone replacement therapy (HRT) is now being approached with caution. The infamous Women’s Health Initiative study, which first disproved benefits of hormone therapy, first pointed out an increase of breast cancer risk and risk of cardiovascular disease. On re-analysis of the data the Journal of the American Medical Association has published a study in its issue of February 23, 2005, which shows some more reason for caution with HRT. The previous notion that hormone replacement would improve the symptoms of urinary incontinence has turned out to be a fallacy. Dr. Susan Hendrix and her colleagues from Wayne State Untiversity School of Michigan in Detroit analyzed the data from 23,296 women with urinary incontinence. In randomized trials they received either estrogen alone, estrogen with progestin (Prempro) or the placebo effect (“fake pills”). Among those who were continent at the baseline, both, estrogens alone as well as the combination therapy were associated with an increased risk of incontinence at one year. Estrogen (Premarine) alone produced the most marked effect: stress incontinence increased by a factor of 2.15, the combination therapy increase stress incontinence by a factor of 1.87. In addition, women who were already suffering of incontinence, tended to report a worsening of their symptoms after beginning hormone therapy. The Women’s Health Initiative trials were stopped because the treatment risks appeared to outweigh its benefits. These new findings tilt the scales even further against hormone therapy, the authors say in their study.

Hormone Replacement Worsens Incontinence

Hormone Replacement Worsens Incontinence

Reference: National Review of Medicine, Canada, March 15, 2005, page 28

Comments on Nov. 8, 2012: We have to keep these observations in perspective. The authors of that study were using the “regular” Big Pharma manufactured hormone substitutes that the body cannot read. There are no Premarin or Provera receptors in the tissue, only testosterone receptors, estrogen receptors and progesterone receptors. These artificial hormones cannot be metabolized in the woman’s body into testosterone as bio-identical estrogen and progesterone would, because they are structurally different from the bio-identical hormones. The sad truth is that an anti-aging physician could have treated these poor women with incontinence safely by prescribing small amounts of testosterone cream that would have had to be applied to the urethral opening. From there the body would have sent it to the bladder, the bladder sphincter and the testosterone receptors that control these tissues and would have taken care of the incontinence problem.  You do not need a clinical trial. This type of treatment has been used in Europe for decades and has been used in the US for maybe 10 to 15 years as well by some open minded urologists and anti-aging physicians. The heading for this post is only applicable for HRT in the conventional sense (using Big Pharma drugs), but none of this applies to bio-identical hormone replacement for menopause.

More info on bio-identical hormone replacement in menopause: http://nethealthbook.com/hormones/hypogonadism/secondary-hypogonadism/menopause/

Last edited October 28, 2014