There are few topics that I discuss more with my patients than hormone replacement therapy and its misunderstood connection to cancer. I must make it very clear that while hormone replacement therapy, when misapplied, can have significant side effects up to and including cancer, the information has been taken entirely out of context and sensationalized such that millions of women avoid this potentially life-changing therapy, relying on poor information based on bad interpretation of data. Let’s dig deeper and find out what’s going on.
The Benefits of Hormone Replacement Therapy
When we think of estrogen replacement, we often focus solely on the benefits related to the vasomotor symptoms associated with menopause and perimenopause. These are the hot flashes that your mom and grandma have almost certainly complained about over the years. However, hormone replacement offers so much more and, when applied correctly and under the guidance and supervision of a qualified physician, can decrease the risk of breast cancer and colon cancer, lower the likelihood of developing Type II Diabetes, give you more energy, greater sexual desire, improved bone health, improvements in cardiovascular health, and, possibly most strikingly, up to a 30% reduction in all-cause mortality.
A Note on Vaginal Estrogen
Vaginal estrogen is a cream or insert that I prescribe to virtually every patient over the age of 40. This is an excellent option for patients who are experiencing chronic UTIs, painful sex, and vaginal dryness because of age and menopause. Because vaginal estrogen is placed within the vagina in small quantities and only twice per week, there are virtually no side effects and, indeed, no systemic concerns because estrogen never reaches the bloodstream. Learn more about vaginal estrogen on our blog here and, of course, speak to Dr. Taghechian about this rejuvenation treatment.
The Continuing Misunderstanding
When the seminal study on hormone replacement therapy (estrogen) and cancer was interpreted, it lumped all women of every age into one grouping. And yes, when doing that, it showed that there was a risk of cancer and cardiovascular events associated with HRT. However, what the data later showed, after many more years and better interpretation, was that this risk primarily occurred in patients who started estrogen replacement 20 or more years after their last menstrual cycle.
Why would this matter? Well, later in life, our arteries have accumulated more plaque, meaning that the vasodilating properties of estrogen could cause the plaque to separate and lead to a stroke. Similarly, later in life, we may have microscopic breast cancer cells fed by the influx of estrogen. No good, for sure, But what about younger women?
The Right Time to Introduce HRT
On the other hand, the timely introduction of estrogen replacement therapy has, frankly, unbelievable benefits. These benefits are maximized when patients begin their HRT during perimenopause or within the first ten years after their last menstrual cycle. For these patients, all the benefits mentioned above are typically enjoyed, and then some.
For patients who begin their HRT between 10 and 20 years after their last menstrual cycle, the benefits are commensurately reduced but still significant.
Now, it is well known that estrogen-only HRT can increase the risk of endometrial cancer in those patients who have an intact uterus, but this can be circumvented with the addition of progesterone.
Hormonal Pellets and the “Right” Physician
While it may sound fantastic to be under the care of a “women’s clinic,” it truly does matter what the goal of the prescribing physician is. Sadly, “bio-identical hormonal pellets” are in vogue today, but they are widely misused and are not FDA-approved. Dr. Taghechian does not believe in prescribing hormonal pellets because there is an overreliance on compounding pharmacies to create the right concentration and ensure quality control. These compounded pellets are not scrutinized by any governing body and are not FDA-approved. FDA-approved options like patches and pills are far more predictable, and their approval ensures oversight and accountability. It is only the FDA-approved medications that have been studied vigorously and vetted, NOT “bio-identical hormone pellets.” Unfortunately, pellets are far more lucrative for the prescriber, and less scrupulous providers have taken advantage of this and their patients’ trust in their medical knowledge.
Further, many female health-oriented physicians have not received the training or are not interested in hormone replacement therapy. As such, when patients visit their gynecologist or primary care physician, many don’t have the training or understanding to get them on the right track.
The Bottom Line
It is true that estrogen replacement therapy is not suitable for every woman, and this becomes truer the longer the patient waits after their last menstrual cycle. However, there is a great deal of misinformation and confusion surrounding HRT for patients nearer to their menopausal and perimenopausal days. For these patients, the benefits of HRT are undeniable and almost universal, except in unusual cases.
Perimenopause and menopause represent a significant change in a woman’s life, and there are very few positives to riding it out without taking advantage of possible mitigating treatments, including hormone replacement therapy. Of course, seeing a qualified physician like Dr. Taghechian is a significant first step in understanding more about the benefits and risks of hormone replacement therapy. We look forward to seeing you in our office and discussing the best steps forward.