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October 19th, 2010
04:01 PM ET

HRT increases breast cancer death risk, study confirms

A study published in the Journal of the American Medical Association confirms that postmenopausal women who take combined hormone replacement therapy (HRT) are at an increased risk of dying from breast cancer.

"Women on combined hormone therapy with estrogen plus progestin were twice as likely to die from breast cancer compared to women receiving placebo," says medical oncologist and study author Dr. Rowan Chlebowski.

The researchers looked at more than 16,000 postmenopausal women who were part of a large government study called the Women's Health Initiative. The women took either Prempro, a drug made by Pfizer that combines both estrogen and progestin, or a placebo or sugar pill. In 2002 the study was stopped early after five and a half years of treatment because of concerns about heart health, breast cancer and other health problems. This latest research looks at 11 years of follow-up on the health of these women and the authors found that those who had used the therapy were not only more likely to develop but to die from breast cancer.

For decades women have been prescribed HRT – medications containing female hormones to replace the ones the body no longer produces after menopause. These drugs can be very effective at alleviating the hot flashes, night sweats and other discomforts of menopause.  They have also been shown to help with bone health and may decrease the risk of colon cancer. But HRT, long heralded as being protective for heart health, has not lived up to its billing and women are now warned about the possible increase risk for heart attack and stroke. Last year a study found that combined HRT also increased a woman's risk of dying from lung cancer.

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Dr. Peter Bach, pulmonologist from Memorial Sloan-Kettering Cancer Center in New York, who was not involved in the most recent study, wrote an editorial published in the journal editorial.  It reads in part: "It took a lot of work for these investigators to unwind what ended up being a lot of incorrect assumptions about the safety of hormone replacement therapy particularly with combined agents like Prempro."

Pfizer, maker of Prempro, released a statement in response to the study: "As a science-based company, we take this analysis seriously. It is important to view the data in the full context of both the symptoms of menopause as well as the extensive body of information – developed over more than 60 years – on the known benefits and risks of hormone therapy."

The use of combined HRT declined sharply in the United States after the HRT part of  the Women's Health Initiative study was stopped in 2002. Researchers have subsequently seen a decline in the rate of new breast cancer cases. 15 to 20 percent of postmenopausal women now take HRT, down from 35 to 40 percent prior to the study.

Medical experts recommend that if women choose HRT, they take the lowest dose for the shortest duration. Check with your doctor about what is right for you and for information about other therapies that may help alleviate unpleasant menopausal symptoms.

The results of the estrogen only arm of the Women's Health Initiative trial will be released later this year. Estrogen only therapy is the preferred HRT treatment for women who, because of a hysterectomy, no longer have a uterus.


soundoff (221 Responses)
  1. MAC

    It is easy to play Monday morning quarterback and point fingers when diagnosed with cancer. You get cancer because of genetic defects, environmental factors, diet... There is a litany of reasons for the development of tumors. The process of aerobic respiration, or the conversion of glucose into energy, results in the formation of reactive oxygen species. This too causes cancer, but that doesn’t mean we are going to stop breathing. People are not going to live forever so people should at least try to live comfortably.

    October 20, 2010 at 08:31 | Report abuse | Reply
  2. boocat

    I am certain hormome replacement played a major role in my mother's death. She was on hormone replace into her 70's (!!!!???) and subsequently had a series of strokes and passed away. I wouldn't trust any drug company EVER!

    October 20, 2010 at 08:55 | Report abuse | Reply
  3. seeker247

    I tried esradol for two weeks, I had no relief at all for the horrible night sweats, almost constant hot flashing, insomnia, etc. As a matter of fact, I gained aching bones and tender breasts. So I stopped taking them. Maybe that was not long enough to know if it would have helped me, but what I do know is that Marijuana stops all symptoms within hours. I struggle with using it since it is not legal, but when I say it stops all symptoms, I mean it stops all symptoms. It doesn't just ease them, it doesn't just make them better, it stops them. From almost constant flashing to zero....is there anyone on here that can suggest something legal that works as well?

    October 20, 2010 at 08:57 | Report abuse | Reply
  4. xrk9854

    Flawed and misleading study. First, there are many kinds of estrogen. They chose to study a conjugate, man-made estrogen, not a bio-identical one many of us use. Second, they chose to study Medroxyprogesterone, which is NOT progesterone. It is a progetin, but is NOT bio-identical to progesterone. I mention this because, again, bio-identicals are available and many of us use them. I don't think a study has been done yet to evaluate bio-identical hormones. In addition someone else pointed out the average age of the people in this study is a little high. Older people have MANY risk factors of which hormones are just ONE. Overall this new study mean nothing to me because I am younger and I am using bio-identical hormones. How about we get somebody to study that!

    October 20, 2010 at 09:12 | Report abuse | Reply
  5. Jackie

    I agree with evoc....someone needs something other than HRT....perhaps some zoloft will help you.

    October 20, 2010 at 09:13 | Report abuse | Reply
    • Becky

      What we need is all natural no side effect from food solution, can you recall that Fasomax an anti osteoporosis drug was recalled for the side effect of bone braking. This product has made a difference for many, and given many there lives back; please check out my website. http;//beechris.reliv.com

      October 20, 2010 at 14:31 | Report abuse |
  6. JK

    Try eating healthy & exercising... there is no magic pill!

    October 20, 2010 at 09:15 | Report abuse | Reply
  7. Cancer Survivor

    For anyone struggling with breast cancer or looking for further cancer information, I recommend checking out http://www.nccn.com/ they have a great deal of information in regards to cancer as well as treatment options and cancer treatment centers.

    October 20, 2010 at 09:28 | Report abuse | Reply
  8. Susan

    I don't understand those who keep saying that bioidentical HRT is not FDA approved and is a scam....this is not so. FDA approved bioidentical HRT include Climara and Vivelle-Dot patches, Estrace pills and Prometrium (which is a micronized progesterone, not a progestin).

    October 20, 2010 at 09:31 | Report abuse | Reply
  9. john

    First, the increase in breast cancer rates is small, in absolute #s, only a couple more cases per 10,000 women. Women with a strong Hx of familial breast cancer should be advised against hormones use. All women should have yearly mammograms over 40, especially if on HRT. Second, the women's health study had many women aged 70-79, which skewed the cardiac effects (these women already developed arterial disease). For women 50-60, there is a decreased risk of cardiovascular events and decrease in overall mortality. Third, transdermal, bioidentical estrogen & progesterone may give a different result than the prempro, which is a synthetic oral preparation. The Kronos Institute is looking at that right now with micronized progesterone and climara patches.
    -Dr. John

    October 20, 2010 at 09:32 | Report abuse | Reply
    • ruth smith

      My mother had HRT, and now is dying of cancer. First breast, and then it spread everywhere. Finally now in her brain. There is no family history of cancer. I believe putting any extra drugs or changing our natural body cycles has the possibility of negative effects.
      Only 10,000? Even if one person died of this treatment it should be shared and become a concern. Those are 10,000 women whose lives have been cut short.
      My daughters are now going to have to grow up without the best grandmother in the world.

      March 19, 2012 at 15:45 | Report abuse |
  10. john

    Don't look at the headlines, read the actual #s. The increased risk is small in absolute #s and HRT should be decided on a case by case basis. Some women feel miserable at and after menopause, including memory changes, depressed moods (anti-depressants aren't always the answer, they have side effects too), sleep disturbance, urinary symptoms, lack of sexual desire or pleasure, anxiety, metabolic changes. We should not be basing our decision to help women alone on the small increased risk of breast cancer. Again, women aged 50-60 had certain benefits in the women's health initiative. It was the older women who had increased cardiovascular risk. These are facts, not a headline.

    October 20, 2010 at 09:35 | Report abuse | Reply
  11. john

    Look for the Kronos study to publish results...I believe in 2012. They are studying FDA approved bioidentical climara patch (estradiol) and micronized progesterone. When you look at the structure of Provera (in Prempro), it is quite different than natual progesterone...that has to have an effect in the body.

    October 20, 2010 at 09:37 | Report abuse | Reply
  12. Joanna Sue

    I think it should be pointed out this "Study" used Prempro which is basically Premarin. The Estrogen in this is not the same as human Estrogen as it is refined from the urine from female horses which are catheterized, confined, and "milked". The product once introduced into the human body resembles human Estrogen but it is not identical. There are other Estrogen based products available that are refined from plant Estrogen that do end up chemically identical as human Estrogen available but were not used in this study. Additionally any oral Estrogen product stresses the liver which may also be a factor in the results noted in this study. There are other methods of introduction of Estrogen into the body such as patches, injection or implants, that are far less stressful on the liver but they were also not examined from what I have read. Pifzer makes millions of dollars per year producing and marketing Prempro and Premarin which they know is not chemically the same as human Estrogen but they continue to sell it because it is profitable to do so. Doctors who prescribe these Pifzer marketed hormones to women are remiss in their duty to the patient in my opinion. This study that says it is only Prempro used also is basically flawed for that reason as well. The News Media covering it also is giving only half the facts in their coverage from what I can see.

    October 20, 2010 at 09:54 | Report abuse | Reply
  13. Sara

    All you saying your body treats all estrogen the same are only thinking about when the estrogen binds to its receptor. It's when it gets broken down in the liver that the difference is seen. Horse estrogen IS NOT broken down in the liver properly. This is what causes the breast cancer.

    October 20, 2010 at 09:55 | Report abuse | Reply
  14. Terry L.

    Mainstream Media is again grossly misleading the American Public. Hormone Therapy has gotten a bad rap over the past few years due to the very flawed results and analysis of the WHI study of 2002, sports figures abusing hormone therapy, and NOT making the distinction between HRT and (the misnomer) Bio-Identical Hormone Therapy. HRT is Synthetic, man made, hormone substitutes. BHRT or N(natural)HRT are chemically structured identical to a woman's own biologically produced hormones originating from all natural substances such as soy and yam. This is a huge difference that the media fails to explain. ProgesTIN is a synthetic replica, progesterONE is chemically identical to a woman's progesterone, just as the name is the same. With this new breaking story about higher rates of breast CA with HRT will be misunderstood and NHRT will be lumped into hormone replacement therapy. This should be a big blow to pharmaceutical industry, as finally more evidence to support the black box warning on synthetic HRT. The World Health Organization has known since 1995, that synthetic HRT and Birth Control Pills were carcinogenic. Yet, it is still handed out like candy to menopausal women seeking relief, only to perhaps develop breast cancer years ahead. NHRT hormones are the same that our human bodies produce. Identical. No synthetic additives exist in them. Do you really think that our human bodies were made with ticking time bombs for breast cancer? Is that logical? When is medical science going to realize that it cannot make intricate substances such as hormones with foreign ingredients and not expect to have adverse outcomes? HRT, then anti-depressants are a certain course to ineffective treatment and also possible cancer development. Replacing natural identical hormones is and has been proven by many studies in Europe, and worldwide, to be safe and effective, and not cancer causing.

    October 20, 2010 at 09:57 | Report abuse | Reply
  15. Stephanie

    Get real about the eating of more veggies, no smoking, a lifestyle of peace, exercise, fresh air, etc. for preventing breast cancer .Sorry folks, none of these factors apply to me. I was a dyed in the wool vegetarian, who never drank, or ate any meat products, eggs, or the like for over 30 years before I got my first breast cancer. I never smoked, drank and lived a healthy lifestyle. I have always been slim. Guess what? I got breast cancer! I got it twice! I also had a complete hysterectomy after the first round which threw me into surgical menopause at age 54. After that, I lived a torturous life of intense sweats, hot flashes, body aches, I could barely hold down a job. I became very sick from all these symptoms. After 5 years of intense suffering (not kidding) I succumbed to taking the bio-identical HRT (combo/ progesterone, estrogen) as life became unbearable. I was at war with my body. The relief was amazing. I never felt better in my life. After five years of this therapy I contracted the second breast cancer in the opposite breast. I went to the Mayo Clinic for the second round. I was told that it didn't matter whether the estrogen came from a natural source or not. It is all estrogen and has the same effect on the body. I was devastated. I was forbidden to take anymore estrogen. Since then going offf the HRT and after this second round, I started getting UT infections and bladder infections at least once a month over a period of years. I was told by several doctors that this was due to the lack of estrogen in my body. Estrogen acts as a protective barrier to the vagina, UT and bladder. As a result I have developed inflammatory vaginitis along with other infections in the same area and internally. I am now being treated for this hideous disease. My doctor at the Mayo Clinic told me it was the next worst thing to having cancer. He put me on a regime of estrogen, sulfa drugs and antibiotics for a period of 4 to 6 months. This disease has caused me great pain and suffering. I have been in and out of the ER several times for the severity of the. pain. Without some form of estrogen, you will lead a life of misery and be subjected to all sorts of illnesses you cannot even imagine. Now, to make the situation more interesting, I have been diagnosed with BRCA 1. You see, it wouldn't have mattered what I ate or what my lifestyle was. I am sick and tired of doctors telling me how to live my life and what not to eat. Why don't they ask me about my diet and lifetstyle before making their assumptions? It's a nasty business to assume that everyone who falls into the breast cancer category is a meat eater and lives an unhealthy lifestyle. There is no excuse for this. Why is this? Because, they have no answers. Good luck to all of you. That's all I can say.

    October 20, 2010 at 10:04 | Report abuse | Reply
  16. Linda

    This is an excellent article about using Pregnant Mare Urine in HRT Drugs such as Premarin and Prempro.
    http://tuesdayshorse.wordpress.com/2010/04/20/premarin-mares-and-foals-aprela-the-lesser-evil/
    There's a whole new class of PMU-based drugs headed for the marketplace. They're being marketed under names that disguise the PMU component and recommended primarily for osteoporosis treatment (for both women and men), but will also be used for HRT. The mares may also have been given drugs that are now known to cause cancer (such as Bute for pain) in their lifetimes. I don't know if these possible links have been studied. Since there are other effective treatments which aren't PMU-based, I hope both physicians and individuals will carefully consider the source of PMU and the inhumane way it's collected.

    October 20, 2010 at 10:08 | Report abuse | Reply
    • Linda

      If this isn't enough to convince you to reconsider PMU for HRT, look up Horse Slaughter videos on the internet and see what's in store for these animals. If you make it through one video without retching, I'll be surprised.

      October 20, 2010 at 10:20 | Report abuse |
  17. Becca

    Something most of the woman in Chemo therapy already knew when I was there, all had a common thread -HRT. Think once again big money for the drug companies encouraged the use of this drug and it went on far too long costing lives. Beginning to really wonder if we do have the best healthcare or just the most expensive.

    October 20, 2010 at 10:08 | Report abuse | Reply
  18. helen

    My aunt has been on HRT since her 30's due to hysterectomy. She is now 87. Isn't that ridiculous. Her Dr. just now put her on a smaller dose,than what she had been taking, but I don't think this is safe. Is there any material that says how long one should be on HRT?

    October 20, 2010 at 10:14 | Report abuse | Reply
    • Larita

      My Mother was also on HRT (Premrin w/o progestern) until she went into a nursing home at 84. She had been on it since her 30's also. They completely took her off and she aged overnight. She had NO cancer her entire life. A little high bp but that was it. She passed away at 88. I keep wondering how long she would have lasted if they had kept giving it to her.

      October 20, 2010 at 11:07 | Report abuse |
    • john

      Even synthetic HRT seems to show significant benefits for at least 10 yrs post menopause. The question is if/when to stop them. According to the Women's health study, women 70 and over should not start HRT because of the increased risk of heart disease (probably disturbs arterial plaques that have already formed). We need large studies on the bioidenticals.

      October 20, 2010 at 14:04 | Report abuse |
  19. Marianne

    At the age of 42 I was suffering from migraines which lasted 4 days before the start of each menstrual period. Then when my period began, it lasted for two weeks, during which time I had very heavy bleeding. The cramps and leg pain I endured were awful, and not relieved by any meds. All testing was normal except for hormone levels. My OB/GYN started me on Prempo which allowed me to live a normal life. I took it for 8 years. When I discontinued it, I had one normal period and that was it. I was through with menopause, and just experienced some hot flashes which were tolerable. Would I take the Prempo all over again, knowing what I know now? You bet your bottom dollar. It allowed me to have a normal life, and not just for 2 weeks a month. I am now 58, am vigilant with self exam and mammograms, and yes, I hope I don't get breast cancer. But I am happy that I was allowed the opportunity to life a normal life while raising three kids, and while also enjoying a good married life! Sometimes you have to make some tough decisions...

    October 20, 2010 at 10:30 | Report abuse | Reply
    • Lydia

      Marianne, I can really relate. I went through a very rought perimenopause. My periods were 8-10 days long and I started to have extreme mood swings that threatened my marriage and friendships. I just felt flat out enraged about half the time. It was miserable. Within days of starting HRT (low-dose Vivelle dot) I felt I had my life back.

      October 20, 2010 at 11:57 | Report abuse |
    • john

      The vivelle patch is a bioidentical estrogen and may be safer than the Premarin.

      October 20, 2010 at 14:05 | Report abuse |
  20. Beth Rosenshein

    No drug studies exist that confirm the 'HRT' given the recruited women contained replacement dosages of ovarian hormones. The Women's Health Initiative never measured the hormone levels before the women received the 'HRT' or after they received it. If hormone levels were measured then everyone could easily see that replacement was not done at all.

    The few drug studies that exist on the 'HRT' that was used in the WHI shows that it actually lowers ovarian hormones levels and creates a previously rare illness in women, hyperestrogenism. The results of the WHI show what happens when dozens of androgen levels are reduced below menopause levels and estrogen is raised to dangerously high levels.

    Dr. Rowan Chlebowski’s conclusions are unscientific and he should be called on it. If he is going to say that HRT has health risks then he should be able to prove that HRT was used. Since no drug studies exist to support his claim that ovarian hormone levels were replaced he is being unethical making these statements.

    The gold standard in replacement therapy in medicine is to measure levels carefully and replace with human (bio-identical) hormones. The WHI did neither. To be called replacement then replacement had to be made.

    Ask yourself these questions. Why would the WHI, a half billion dollar study, say they used HRT and not prove it with testing hormone levels? What would you think of a half billion dollar thyroid study that had a poor outcome that didn’t measure how much thyroid hormone was used? What would you think of a half billion dollar diabetes study that had a poor outcome that didn’t measure how much insulin was used?

    Ovarian replacement is no different. The levels of hormones were not analyzed and improved upon because no levels were measured. The few drug studies that do exist on Premarin demonstrate that the opposite of replacement takes place along with an overdose of estrogen.

    This article is nothing more than yellow journalism fueled by Dr. Chlebowski’s unscientific paper in the Journal of the American Medical Association. The results of the WHI are no more applicable to women’s health than an overdose or underdose of any other replacement hormone would be.

    Beth Rosenshein
    Diamond Research Foundation

    October 20, 2010 at 10:30 | Report abuse | Reply
  21. Brian

    "Another baloney study!! the average age of women in the 2002 study was 63. The average of of menopausal women is actually 53. Somehow, more heart attacks, strokes, cancer in these women was a surprise!".......

    We should have a study of studies to determine why most studies lack credibility. Some diseases have been "studied" to death with hundreds of studies and the results are all over the place depending on the agenda of the people doing the study.

    October 20, 2010 at 12:13 | Report abuse | Reply
    • john

      Even earlier Brian, average age of menopause is 51. The average age in the women's health study was just over 63. HRT reduced the 10yr risk of heart disease in women who started HRT within 10 yrs of menopause. The bottom line is HRT is not for everyone but should be available for women who have significant sx (and/or lack of breast CA and stroke risk factors)

      October 20, 2010 at 14:13 | Report abuse |
  22. Not All Docs Play Golf

    These reports bring out all of the "bioidentical" and "alternative medicine" fruitcakes. These people cannot be swayed by science. I previously recommended that people read the position statement from the American College of Obstetrics and Gynecology cautioning women about the marketing of "bioidentical hormone therapy" ( ACOG Committee on Gynecologic Practice. Compounded bioidentical hormones. Obstetrics and Gynecology 106:1139-1140, 2005.) and I got attacked for offering that resource by several of the alternative folks on this blog. Believe the earth is flat if you want, but if you want some valid data about "bioidenticals", see what a responsible source like the ACOG has to say, or check out this info: http://www.pharmwatch.org/strategy/bioidentical.shtml. If science won't sway you, stick to your aroma therapy practitioners and don't waste the time of board certified mainstream physicians, but don't criticize those of us who practice evidence-based mainstream medicine. It saves lives today in so many areas of medicine.

    October 20, 2010 at 12:22 | Report abuse | Reply
    • john

      Are you unaware that climara, vivelle and micronized progesterone are all FDA approved bioidentical hormones? We need more data on women who use these forms of HRT to have an accurate comparison. As I said, the Kronos study is looking at this. Take a look at the chemical structure of MPA and see how different it is from the natural form of progesterone...it is worth studying. Did you see the endocrine society's recent statement from their annual conference about the saftey of HRT in younger women? With your closemindedness view and bitterness toward integrative thinking, you were appropriately attacked. Doctors like you denied the benefits of fish oil and vitamin D too.

      October 20, 2010 at 14:18 | Report abuse |
    • CB

      Obviously, modern medicine was once "alternative medicine", you forget that.
      Sadly, you are so one minded and not very wise in your choice of words, or opinions on "alternative medicine", which works for many. Perhaps if this became popular YOU would lose your job, I think that's the part that bothers you, that your arrogant wisdom might be challenged, and perhaps those perks from Big Pharma might end also........they laughed at the Wright brothers – as well as with Pasteur at one time.

      October 20, 2010 at 16:32 | Report abuse |
    • Susan

      You need to read your own offered article, Not All Docs Play Golf! Read the title:
      ACOG Committee on Gynecologic Practice. COMPOUNDED bioidentical hormones. Obstetrics and Gynecology 106:1139-1140, 2005 COMPOUNDED!!!!! This is NOT the same as FDA approved bioidenticals such as the Climara and Vivelle-Dot patches. So glad YOU aren't my doctor....you obviously cannot even read!

      October 20, 2010 at 17:13 | Report abuse |
  23. John Richards IV

    Look at the Provera side of the PremPro. Provera ( MPA ) is not a good product.

    October 20, 2010 at 12:57 | Report abuse | Reply
  24. Virginia

    If you can clean up diet (organic vegetables, fruits, don't overdo soy as it can mess with your thyroid, cut out sugar, drink enough water, avoid processed foods, work with a good up-to-date nutrionist can really help, plus raw food/vegan/etc. diets have become more flavorful and enjoyable), move from coffee to green tea, exercise a few times a week. Get enough omega 3's, krill and flax oils are good, wild alaskan salmon.. Enough Vitamin D3... natto (Japanese breakfast) is good for calcium... If you eat meat, eat organic free-range, etc. I used pre-cooked Royal MACA for hot flashes... it worked pretty quickly and only used it for a few months.. rhodiola rosea can help with depression, low energy...

    October 20, 2010 at 13:34 | Report abuse | Reply
  25. Karen Jackson

    Why was it when it was suspected that I had "breast cancer" did my doctor's office call in a panic and say to me "STOP TAKING THE HRT!!! I firmly believe the cause of my breast cancer was indeed due to taking the HRT. No one can tell me otherwise.

    October 20, 2010 at 14:19 | Report abuse | Reply
    • Pam

      Hi Karen, I believe you. I took Premarin and Provera for menopause for eight years and developed breast cancer. Had to have a mastectomy Nov. 2001 followed by chemo and then reconstruction. I too believe my cancer was caused by HRT.

      October 8, 2012 at 21:03 | Report abuse |
  26. Maggie

    I, like VeggieHead, have and am still experiencing at the age of 48 zero sleep, constant, and I mean constant hot flashes, depression, anxiety, irritability, mood swings, hair falling out, total exhaustion. I cannot stand to be spoken to, nor do I have any tolerance for anyone or anything. I took PremPro in 2007, 2008 and then in 2009 had the nice surprise of microcalcifications and had to resort to having wires inserted into my left breast and race surgery to have the cluster removed in August of this year. I am miserable. I am now also terrified to take HRT. I have just had blood work done to try and see if a thyroid issue is causing this life I call hell. I thank god I am still employeed, married and my children still speak to me. I will now research BHRT and discuss this with my gyno. I cannot live like this any longer. So for those of you who feel that a hot flash is something that will pass, try having them 20 to 30 times per day, literally. It is not normal.

    October 20, 2010 at 14:39 | Report abuse | Reply
  27. Susan Kranyik

    Some of you are so nasty to each other; angrily and sarcastically telling someone they should take drugs for their mental state is the definition of ironic.
    Hormone replacement therapy is only safe when it comes from plants. Anyone with estrogen receptor positive BC(like me) are not supposed to use chemical hormone therapy; phytoestrogens are a different story. Also, for folks having 30 hot flashes a day, try 37mg of Effexor.

    October 20, 2010 at 15:22 | Report abuse | Reply
  28. No Fan of HRT

    When I had my physical last year, my physician and I discussed menopause as I am approaching that point in my life. I told her that I was not at all interested in HRT. She said "good, because if you were, I would have to refer you to another doctor. I will not prescribe HRT." This is coming from a physician at one of the top hospitals in the nation. I think having to endure some night sweats, hot flashes and whatever other symptoms you may have to experience is far less disturbing than the fear of cancer and the possibility of death.

    October 20, 2010 at 15:41 | Report abuse | Reply
  29. Dr. A

    The main issue I have with the way the study is being reported right now is that the data is being extrapolated to include all hormone replacement therapy. This study is concerning only if you are taking the combination of Premarin and Provera otherwise known as Prempro. It is not true that bioidentical estradiol acts the same in your body as conjugated equine estrogens, which is what Premarin is. It is also not true that natural bioidentical progesterone acts the same way in your body as the hormones depicted in this study.

    Bioidentical hormones have the exact same structure in your body as hormones that your body would naturally make. The hormones in Premarin have a very different structure than natural estradiol. Because of that different structure, they are going to attach differently to the receptors on the cells of tissues such as breast, endometrium and brain. More importantly, in the case of Premarin, it is going to metabolize differently.

    In the case of bioidentical estradiol, the molecules are eliminated from your body within a few hours. Conversely, the metabolites from Premarin have been shown to stay your body for up to 13 weeks! This is because your body's enzymes are designed to metabolize your own estrogen not equilin. Interestingly, if you look at the Premarin-only arm of the Women's Health Initiative from 2002, there is neither an increase or decrease in mortality between Premarin-only and placebo. Even in this current study, it states that women with a hysterectomy who are only on Premarin do not have an increased risk of breast cancer. That being said, the obvious problem with the drugs in the Women's Health Initiative is Provera or medroxyprogesterone acetate, progestin.

    A study of more than 54,000 postmenopausal women in France compared risk of breast cancer among women using HRT such as Premarin and Provera or bioidentical hormone therapy for nearly three years. Risk for breast cancer increased by up to 70% among those women taking progestins, such as Provera. Among those taking bioidentical progesterone, the risk actually decreased by 10%. A longer term French study tracked more than 80,000 postmenopausal women for just over 8 years. It compared breast cancer risk among women using estrogen and bioidentical progesterone versus estrogen and progestins. Risk increased up to 90% among those using progestins such as Provera but did not increase among women using bioidentical progesterone.

    At the end of the day, the decision to use home replacement therapy is one to be made between the patient and her physician. However, I believe it is very important to be able to interpret the data correctly. You cannot extrapolate what happens in the body using Premarin and Provera to discuss what happens in the body with its own natural hormones.

    October 20, 2010 at 17:04 | Report abuse | Reply
    • Terry L.

      Right on Dr. A. I am assuming you are referring to the Fournier study. By far the most outstanding one done. I am disturbed by the public's perception that ALL HRT is bad. All hormones are bad. That is what the everyday Jane or Joe will get out from this "breaking news story'. When we both know, the right , natural hormones are good, necessary and protective.

      October 20, 2010 at 17:22 | Report abuse |
    • john

      Excellent post. Too many doctors are not reading the details of these studies and not looking at the smaller studies using the bioidenticals. These results are specifically for Prempro, just as you pointed out. They cannot be extrapolated to the effects of other medications. Again, we need more studies but for now the decision needs to be made on an individual basis. Women have different experiences with menopause and some benefit immensely from therapy. Remember, 1 in 7-8 women develop breast cancer so it is unfortunately very common with or without HRT. However, I have no tolerance for doctors who do not appreciate the symptoms certain women go through during and after menopause. They other concerning issue is the memory loss some women experience.

      October 20, 2010 at 20:39 | Report abuse |
    • CB

      John, your first sentence is right on. They are not reading the details of these studies – why? I assume they do not have time with all the red tape, paperwork, etc. that needs to be done to keep a practice open – heaven help us if this health care bill disaster is not REPEALED.

      October 22, 2010 at 17:02 | Report abuse |
  30. Terry L.

    In complete honesty, having been a medical professional for 40+ years, the FDA is the culprit that needs a long term double blind placebo controlled study! Estriol, the most promising form of estrogen, and safest form, is NOT FDA APPROVED. It is classed as an "Investigational New Drug" Ha Ha! New? I do not think so, it has been around as long as women, Drug? Hardly not, it is a natural hormone women produce and the fetus in utero is bathed in it! I will give them investigational, since the backward conservative U.S. has not studied it yet. Though there are a 1000 studies out there from Europe (inc. from Wyeth) that have proven its safety and efficacy. FDA is run by Big Pharma.......Look what happened to Viox after 5 heart attacks.....how many breast cancers have been caused by premarin/prempro?

    October 20, 2010 at 17:10 | Report abuse | Reply
  31. jj

    I took PremPro for about a month after menopause, then stopped because my legs hurt (don't know the connection, but the leg pain stopped when I discontinued the drug). Toughed it out during hot flashes and I'm glad I did. The three people in my family who have had breast cancer all took hormones. Those of us who did not take anything have not (yet) had breast cancer.

    October 20, 2010 at 18:03 | Report abuse | Reply
  32. Jeff Smith

    There should be no surpise regarding the outcome of this study. This was a study of what happens when you try to replace a woman's natural hormones with a drug company concoction of horse urine extract and a "close but unnatural enough to be patentable" knock-off of human progesterone. Of course there was a toxic reaction. What bothers me about the study is that they continue to use language inaccurately. Horse urine extract is not "estrogen" to human females. And, of course, when the news media report on this story, the language gets sloppier and more inaccurate as it goes along. NBC's Today Show piece by Dr. Snyderman is a prime – albeit sad – example. This is supposed to be science – where words have specific meanings. An MD who is the Chief Medical Editor for NBC ought to know better.

    October 20, 2010 at 18:10 | Report abuse | Reply
    • Susan

      I agree...I was completely disappointed in Dr. Snyderman's discussion of this study this morning. She kept using the word "progesterone"....this study was not about progesterone! It concerned progesTIN! Big difference!! She did a huge disservice to the viewers of the Today show by using the wrong word and her parting snark about those of us who take bioidenticals was unprofessional and uncalled for, in my opinion. I lost a lot of respect for her today.

      October 20, 2010 at 20:26 | Report abuse |
    • debbie

      I agree that they're completely misleading about the actual hormones. Equine Estrogen Complex (Premarin) consists of many, many different forms of estrogen. Premarin is 50% estrone, which is also produced by body fat. It's seriously implicated in the rise in cancer rates in obese people. This study has no bearing on women (like me) taking only estradiol and doing just fine with it. It's a typical case of oversimplification for the masses.

      October 20, 2010 at 21:01 | Report abuse |
  33. Eeyore

    Yawn. The same nutty conspiracy theorists are here as they are on every single health topic thread. Stop blabbering your nonsensical screeds about the FDA, "Big Pharma", the CDC, etc., etc., etc. You are tiresome in your idiocy. Go take your crunchy granola cures and stop telling the rest of us what to do. I'm perfectly capable of doing research using reliable, widely accepted sources of information. I don't buy your scare tactics or your silly paranoia.

    October 20, 2010 at 18:43 | Report abuse | Reply
  34. CB

    Why are they nutty Eeyore? Because they differ from what you've been taught to believe. Silly Eeyore, don't be so closed minded and lemming like, take a chance, look around and make your own decisions. There are millions of people who don't buy what is fed to them by the FDA, pharma companies and know their bodies far better than their doctors.

    October 20, 2010 at 18:59 | Report abuse | Reply
  35. Jing Jinag

    Do anybody know that Acupuncture do excellent job to push away hot flashing of menopause? This most natural treatment in the world and proved in China for thousands years.
    Come to acupuncture treatment, may cost more than HRT, but won't increase your breast cancer and death. What a life talk about!
    Dr.Jing Jiang, practice in NY Westcheaster county and Stamford CT with 95 % success rate to alleviate hot flashing, night sweats.

    logon: http://www.jingriveracupuncture.com

    October 20, 2010 at 20:48 | Report abuse | Reply
  36. Gala12

    I am 50 years old now. At 46 I started experiencing premenopausal symptoms – constant migraines, extreme irritation and moodiness, 25 lb weight gain. It all got fixed by low carb diet (30 – 50 gramms of carbs a day) . I am still fine and follow the diet. Don't go vegetarian, ladies.

    October 20, 2010 at 21:01 | Report abuse | Reply
  37. Ronald Lynch Ron from Florida

    Are their any studies that suggest that Bio-Identical Hormone Replacement would increase the risk of breast cancer in similiar numbers as the pharmaceutical hormones which are not bio-identical to what is actually found in a womans body ?
    Have those studies been done yet ? Susanne Somers and others beleive bio-identicals are safer Any feedback ?

    October 21, 2010 at 13:31 | Report abuse | Reply
    • Kim

      I have not read actual studies on BHRT, however I have read interviews with doctors who are advocates of using BHRT. They seem favorable. Why would a given level of hormones (whether sex hormones or others) be fine for a woman who is in her 20s, and yet not fine for a woman in her 60s? I am speaking of BHRT, not synthetic. Hormones are what keep us alive. When one has a full complement of hormones then the cells are reproducing (repairing) faster than they are dying. In other words you are not decaying and aging as rapidly as if you were using nothing. We are not that far removed from plants in a way. Think of it like this: why are we here, biologically speaking? To reproduce. To perpetuate our species. When a plant does that it flowers and then goes to seed,and then it begins to wither and die. It has fulfilled its purpose as far as nature is concerned. Are we humans that much different? When we stop being able to reproduce, then nature says it is our time. Only in the case of modern humans, that "time" is dragged out over a period of several decades. And why should we resign ourselves to wasting those several decades, to having it be a period of steady and inexorable decline, when there is an alternative? If youthful levels of hormones are such a bad thing, then why aren't doctors advocating that young people (unless they are going to have children) take drugs to block their hormones, or have castration or a complete hysterectomy? That way, they would avoid several DECADES of exposure to those dangerous, "carcinogenic" hormones.

      October 21, 2010 at 23:46 | Report abuse |
  38. Marion

    What a great discussion this article started. I am glad I was the first to post my scepticism. I have learned much from many posters in here......too bad my doctors do not educate themselves as most of you posting here have. When that 2002 study hit the airwaves, doctors saw "lawsuit waiting to happen".....and I am sure many of them never even read the ACOG report at all and went by what the "media" scare reports had to say about it. In my opinion, it is the MEDIA who cause the most misconceptions about these things.

    Please read the following CNN article about the accuracy of most scientific studies....including the HRT study done in 2002:
    Perhaps this article will open some closed eyes.
    http://healthland.time.com/2010/10/20/a-researchers-claim-90-of-medical-research-is-wrong/?hpt=T2

    October 21, 2010 at 17:50 | Report abuse | Reply
    • Kim

      This HAS been a great discussion! I would almost say it would be nice if there were a Yahoo group or something were we could continue to talk about it. The one Yahoo group I looked at was full of spammers. 😦 This topic is sooo needed out there! So many women have so many questions. Having a group of us together to share our personal experiences and help out with support and even just lending an ear would help a lot!

      October 21, 2010 at 19:42 | Report abuse |
  39. chris

    Does this also include hrt vaginal cream also, I am assuming so.

    October 25, 2010 at 14:01 | Report abuse | Reply
  40. iris

    I have a question. I had fibroids removed when I was 48. I was suffering with heavy heavy periods . So my gyno asked me if I want ed to have my uterus and cervix removed . I agreed . I went immediately on the vivelle-dot patch. Lowest dosage available . I am 61 now . I have never had a hot flash or any symptoms from menopause . EVER. My Doctor wants me to wean off the patch now. I am having vaginal dryness. Can anyone tell me if at this late date if I will experience hot flashes and change in sleep patterns and weight gain. I have Never had trouble sleeping I run 2 to 3 miles a day. and overall am very healthy and breast exams have always been perfect up to now . My mother died of breast cancer at the age of 58. She had been on premerin and estrogens for many years before she was diagnosed. Any advice would be appreciated . Oh,, I was given Estrace for the dryness and possible beginning atrophy. But I am sitting here looking at the cautions . and wonder if I should use it at all.. I am open to any advice.

    October 26, 2010 at 01:35 | Report abuse | Reply
    • Jill

      Please read Dr. John Lee's books about HRT and menopause. I curently am using bio-identical hormones and no longer have hot flashes, night sweats or weight gain. My hair is lustrous and my libido is robust. I anm also on an all natural medication for hypothyroid which has kept my metabolism up and my weight down. Do you research before you start using any type of synthetic hormone

      November 4, 2010 at 16:51 | Report abuse |
  41. tina

    I am one years post total hysterectomy. My hot flashes were completely unbearable and SYNTHETIC HRT did NOT work for me at all. I have been using bioidentical hormones (natural hormones) for the past several months. They improved my quality of life; my marriage; and possibly saved my life. No doubt. They are made by compounding pharmacies who work in conjunction with a physician.

    November 2, 2010 at 16:55 | Report abuse | Reply
  42. Jill

    the problem is progestin. it is poison. What you want to take in conjunction with the estrogens is progesterone. Bio-identical hormones are the only safe way to proceed. They have save my life. There is much relaible research online. Dr John Lee is a good place to start. NEVER TAKE ESTROGEN WITHOUT PROGESTERONE

    November 4, 2010 at 16:45 | Report abuse | Reply
    • freemenow

      Thanks Jill for noting- It is important to stress the difference between bio identical hormones and Synthetic HRT- from pregnant horse urine which is causing all the cancer and killing women.

      November 23, 2010 at 08:58 | Report abuse |
  43. terig

    I have read some of the posts here, though not all, and am surprised that I don't see much about acupuncture and herbal treatment for menopausal sx. It is, in my opinion, the best choice out there. I am an acupuncturist and treat many women for menopausal symptoms quite successfully. Seek out a licensed, natioanlly board certified acupuncturist by going to NCCAOM.org.

    November 9, 2010 at 09:54 | Report abuse | Reply
  44. Ildi

    I was on HRT for 8 years and then decided to stop based on everything I read. I had hot flashes and was miserable but I did not go back on HRT. 3 years later I was diagnosed with stage 2 colon cancer.....is this a coincidence? Had I stayed on HRT would I have had the cancer ?

    November 10, 2010 at 00:44 | Report abuse | Reply
  45. leo

    don't mean to sound stupid here...but is there anything that doesn't cause an increase in breast cancer..it seems like if there is ANY increase, then all the whistles and bells go off and multimillion dollar research projects get funded.
    YET men are dieing of prostate cancer in larger numbers and men are told by doctors..well we will just leave it alone..he probably will die of a heartattack anyway. I wonder how many women would stand for such nonscense. Men don't have a whole month dedicated to their health care..there is no wearing of ribbons/marathons/product placement for prostate cancer.

    November 10, 2010 at 07:49 | Report abuse | Reply
  46. leo

    women want to have it both ways..to be done with periods yet not have hot flashes ...they act like menopause is a disease instead of something that is a natural occurance in women.
    Fine lets give women estrogen..and "WOW" they are suprised that there is an increase in breast cancer!!!!! Well yeah...there is going to be more women with brease cancer if you compare it to women in the same age group that are going through menapause.
    Women receive too much damn estrogen in their lives to begin with...first natural estrogen in their bodies..second through all that birthcontrol..thrid through the environment/plastics etc.. forth through all that soy milk/products pimped to women as being natural/good for them.
    I find it interesting that doctors don't just give older men hormone replacement theraphy...why?..OMG older men will want sex then...people say older men don't need it...
    Yet male hornome replacement theraphy actually helps men..try to get an insurance company to pay for it and you get that viagra argument all over again

    November 10, 2010 at 07:59 | Report abuse | Reply
  47. freemenow

    What you are missing is the difference between bio-identical hrt and synthetic hormones.
    Do your homework ladies.

    November 23, 2010 at 08:54 | Report abuse | Reply
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