December 2010

Q. I am wondering what your most current recommendation is regarding hormone replacement therapy - given the ongoing negative research (although I understand that the numerical differences are quite small). I am using the Menostar patch (14mcg/day) and have been on HRT for nearly 20 years.

A. My opinion has not changed - transdermal estrogen for women at/through menopause along with natural progesterone (prometrium) IF you still have a uterus makes sense from all the data. The newest study simply reminds us what I have said all along - it is likely the synthetic progestin that confers most risk to the breast and should be avoided. Obviously if one has strong family history or other reason to avoid estrogen - they should.

I addressed this in my Q & A's after World News estrogen story last month and mentioned briefly in my interview with Robin in late August on treating menopause:

HRT: Q & A on Study Linking Hormone Therapy With Breast Cancer - ABC News http://abcnews.go.com/WN/hrt-qa-study-linking-hormone-therapy-breast-cancer/story?id=11994959

HYSTERECTOMY QUESTIONS FROM VIEWERS ON WORLD NEWS:
Is the risk higher for women of natural menopause as opposed to women of surgical menopause? My understanding of the study was that it involved women who had NOT had historectomies. What is you advice for a 45 year old woman who has had a historectomy and no family history of breast cancer? Is there data for women who have had historectomies? Does the improved quality of life outwiegh the risk? I had a complete hysterectomy in 1995. I have been on Premarin (.625) since 1995. I am 51 years old. Should I be concerned about a higher incident of breast cancer?

Dr. Marie Savard: You have asked an important question. The study reported in the segment was describing only women who had not had a hysterectomy and who were therefore on a combination of estrogen and progestin (Prempro). The Women's Health Initiative (the original research reported in the segment) also studied women with hysterectomies who were taking estrogen ONLY in the form of Premarin. Women with a hysterectomy do not need progestin which is solely given to prevent the uterine lining build up that estrogen can cause. These women taking estrogen only after their hysterectomy did NOT have an increased risk of breast cancer in the very same study - in fact their risk of breast cancer was slightly lower than women on the placebo or sugar pill but not considered statistically significant. This finding gets much less attention but does lead many physicians to suspect that it is primarily the daily use of the synthetic progestin in the Prempro combination that contributed to the breast cancer risk. Most women following a hysterectomy (women who have not had cancer) are advised to take estrogen at least up until the age of natural menopause - about age 52. On the other hand, some physicians recommend continuing estrogen for longer as it has been found to reduce osteoporosis and fracture risk and to reduce colon cancer risk as well. Your physician can help you decide when and if you should taper off estrogen based on your personal and family history.