This is a very clear explanation of the risks and benefits of hormonal therapy. I was on the fence, couldn’t decide for the longest time, and then frequently second-guessed my decision since my hysterectomy 10 years ago. It all seemed so confusing and complicated. I feel vindicated and relieved after reading this post.
Thank you for the invaluable service that you provide!
Thank you so much for your voice…For analyzing all sides of the data to share with us and for calling out the cherry-picking that is often seen across social channels by other doctors. I was really persuaded by that initially and then very confused when I started reading the studies myself. I truly appreciate your insight.
The problem is not the study. The problem is that we are still relying on a 20+year old study because nobody wants to do any more research. If progesterone is the problem WHERE are the studies on using IUDs instead for instance?
The fact that we do not have more randomized clinical trials with other hormone regimens is a problem. Hopefully, this recent injection of funding will help us get some studies done. But as this is the big randomized trial that we have, it's important to use it correctly.
And they weren’t studying the micronized progesterone that is generally prescribed now, along with transdermal estrogen. I don’t understand how this study really translates to the current MHT types/delivery methods.
thank you for this clear breakdown! It has been tough to decide, and what doesn't help is reading "experts" here on substack and socials talking about the WHI and all its roughly 15 re-analyses with the last largest one by the original authors themselves summarizing that 5 yrs. on estrogen therapy equals = “less” breast cancer, “less” death if you do get it, “less” recurrence, with “less” death if you do get a recurrence. I am not sure if you have already discussed the new article in Menopause (May 2024-Use of menopausal hormone therapy beyond age 65 years and its effects on women's health outcomes by types, routes, and doses). Same "experts" say that this 10 Million NIH/Medicare study showed that older women live longer (19% longer), healthier lives on estrogen replacement.
I already discussed the beyond 65 years article. It is a data base review and observational. Check out the past couple of posts. There is no WHI paper showing a lower rate of breast cancer with combination therapy or with Premarin alone at 5 years that I have seen and it’s not referenced in the 2022 NAMS guidelines. The Premarin results emerged after longer follow up. And with Premarin there is reduced breast cancer mortality. However the long term data presented in this review do not support MHT for disease prevention.
Wonderful synopsis, and I thank you. I'm not sure if I should keep taking my prescribed D and Calcium or not. It doesn't seem to be harming me (maybe some constipation), but I wouldn't want to take it for nothing either. I do have osteopenia.
Would love data and discussion of Vitamin D and calcium only for osteopenia. This choice does not seem to be the “slam dunk” it seems it should be, based on some studies I’ve read.
Great information thank you. If women were using transdermal only estrogen and discontinued it for a short time before 65 can it be resumed for persistent issues in your opinion after 65?
When WHI first 'broke' (along w/ its fallout...) my immediate reaction was 'the pendulum will swing back again.' My 2nd was: 'what this study shows us is that you can't take a bunch of women, 10 yrs post-menop., half of whom smoke, and give them a progestin already known not to be cardio-friendly, and expect it to do any good.' And in the back of my mind was that monkey study (I know women aren't monkeys, but still...) that showed that waiting a while post menop. to give estrogen wasn't going to prevent/treat atherosclerosis.
The new position statement released in January 2024 states in the conclusion if a woman over 65 wants to continue or start hormones the lowest dose is suggested as well as the route non oral as long as a medical history indicates it can be used. This is good news for all of us over 65 still suffering not just hot flashes (as estrogen is not just indicated for use for this purpose alone) but for the other issues we experience.
I would like to read more studies regarding the risk of dementia. I have only been able to access two current ones that were conducted in Europe. Also if a woman has no cardiac issues and suffers from hot flashes not related to another medical reason as well as osteoarthritis concerns would it not be up to that person to make an educated decision with her health care professional? If estrogen (in recent studies) has protective properties for those persons who are suffering why should it not be an option? The new Menopause society updated 2024 does not negate initiation of estrogen, if it is contraindicted why are they not stating that fact? Even one of the past presidents has released a new opinion on the use and initiation over 65.
I have not seen a new position statement from the Menopause Society from 2024, so I cannot speak to your source. The last position paper on hormone therapy from NAMS is from 2022. These 2022 guidelines quote the WHI Memory study, which indicates an additional 23 cases of dementia per year per 10,000 people who take hormones starting at age 65 and older. I can't answer your other questions, as those are questions between providers and patient. People and providers can certainly choose not to follow the guidelines, but that is not something I can address here.
I have the document saved if you would like to read it. Publish date January 2024 Menopause Society. In the Associations with CV and Dementia it states (also there are charts which display the statistics per # of persons, 10 million women) that "transdermal and vaginal ET which should avoid the procoagulant and proinflammatory effects ascribed to liver passage exhibited reduced risk of both dementia and stroke, in accord with the results of other studies". This statement also suggests that vaginal estrogen has more of a systemic impact then some physicians are aware of. Especially for those persons on thyroid replacement. As per my recent communication with Dr. A. Bianco (past president American thyroid Association) all forms of estrogen will impact thyroid medication which means it impacts TBG and a need for a dose increase of T4 is required. I do understand why you would not want to address what other providers are willing to prescribe. The original study Use of menopausal hormone therapy beyond age 65 years and its effects on women's health outcomes by types, routes and doses (Seo H. Baik, PhD, Fitsum Baye, MS, and Clement J. McDonald, MD). It is available in google scholar to download. I can also access it through Jama and the Menopause society website (which does need to be updated). As a university instructor I am able to access more current data as well as studies.
Please give me the name of the publication so I can look for it in Pubmed as it is not listed on the NAMS website nor in any of the emails that I have received from them, as I just went through my email to make sure I had not missed it. I did address the Baik paper in two posts here. This is the first one https://vajenda.substack.com/p/how-long-can-you-safely-take-menopause
full access of the article is available thought the website www.menopausejournal.com scroll through the latest publications. It is a lengthy study, but I like that it includes statistics.
Since the study has been accepted and published by the Menopause Society (formally NAMS) and states "The Menopause Society changed their postion about the use of HT in women aged 65 and older, suggesting that the decision to start or continue HT beyond age 65 years should be individulaized (ie, based on the individual's specific needs, overall health, and medical history) and highlighted the use of lower doses and nonoral preparation to minimize risks of adverse effects" (Seo H. Baik et al). I as well as many women should be advised of this data to make an informed decision.
The paper you are quoting concerns continuing MHT beyond age 65, not starting. They are not the same thing. In the 2022 guidelines, the Menopause Society changed the recommendation about routine stopping at age 65. Here is the entire quote about starting past age 60 from the Menopause Society Guidelines: Initiation of hormone therapy in women aged older than 60 years or more than 10 years from menopause onset has complex
risks and requires careful consideration, recognizing that there may be well-counseled women aged older than 60 years who choose to initiate or restart hormone therapy. For women
requesting to initiate hormone therapy because of VMS appearing many years after menopause onset, further evaluation is needed. Although new-onset VMS in an older woman could be caused by estrogen-deficiency, hot flashes or night sweats may be related to an underlying medical problem (eg, obstructive sleep apnea, hyperthyroidism, carcinoid, lymphoma, Lyme disease, tuberculosis, HIV) or medication or substance use
(eg, antidepressants, antidepressants, hypoglycemic agents, or withdrawal from
alcohol or opioids). Throughout the piece they mention several times the increased risk of dementia seen with starting at age 65 or older from the WHI. Regarding continuing past age 65, here is an excerpt: Of note, the continued use of hormone therapy in healthy women aged older than 65 years at low risk for breast cancer and CVD is limited by insufficient evidence regarding safety, risks, and benefits. For otherwise healthy women with persistent VMS, continuing hormone therapy beyond age 65 years is a reasonable option with appropriate counseling, regular assessment of risks and benefits, and shared decision-making. Hormone therapy also may be considered for prevention of fracture in healthy older women at elevated fracture risk when bothersome VMS persist or when hormone therapy remains the best choice because of lack of efficacy or intolerance of other fracture-prevention therapies.
Long-duration hormone therapy use and use in older women is not appropriate for reduction in the risk of CHD or dementia. When providing hormone therapy to older women, clinicians must remain vigilant about risk stratification and potential mitigation strategies, such as switching from oral to transdermal hormone therapy, choice of progestogen, and lowering of dose.
These conversations cannot happen here online, they must occur in a doctor's office. And of course people should know that in the WHI those who started hormones over age 70 for hot flashes had a 500% increase in cardiac disease. Of course that is oral therapy, but it is important information. In addition the risk of breast cancer does increase with duration. Al of these things are to be discussed and then individual patients and providers can come to decisions that work for them.
Question: For those of us that did start HRT before the age of 60 and are now approaching the age of 65, does the report suggest we should stop taking HRT once we reach 65?
Wow! 🤯 first time REALLY understanding this study. I had always heard the msg (from other MDs as well on podcasts etc) that study was all bad. Now: Mht is all good. Especially the new msg that mht is a wonder disease prevention. I appreciate the detail written here- thank you as always!!
Yes, there is a weird "MHT has zero risks and is the cure for longevity" message that is permeating social media, and a lot of it is based on this study, I believe, but that would not be a correct position. So, it's important to set the record straight. There are risks with MHT, more so with combination therapy. Most people would consider those risks worth it for treatment of hot flashes or night sweats of depression in the menopause transition.
Thank you for this thorough review! My mother always said she couldn't get MHT because of her risk for blood clots and just suffered through the symptoms for decades. I wonder if this means she could have actually taken it to reduce her symptoms?
It's why women my age group (68) are furious. Doctors would not subscribe any hormones and they took their women patients off any and all hormones. I was the only one that refused to go off estradial. I had my uterus and ovaries removed at 50. I had to shop for a doctor, do annual mammograms, get my arteries scanned, etc. As she said we have a right to be EXTREMELY angry. My friends all gained 20-40 lbs and suffered many sleepless nights. It's been more than 10 years since their last period, so they can not get estrogens prescribed. A whole generation of women continue to suffer. Knowing that it is because the study was misinterpreted and reported does NOT help. It actually makes me madder.
This is so helpful, thank you. I am super curious about the HT cancer risks for non-drinkers (of alcohol) vs. moderate drinkers. Do you know of any information out there?
wondering if there is any research on knowing where is a good place to apply estradiol gel. Knowing there are many estrogen receptors on or shoulders neck and hip areas. is it coincidence that many althralgias occur in these places for women that are premenopausal and post menopausal? would it placebo to think shoulder pain has dissipated after applying gel to shoulders for several days?
is there any research on this i have been struggling with pain in my shoulders post frozen shoulder and thought i would try it after 2 applications it was gone… so crazy
A friend who follows Peter Attia is convinced that the risk of breast cancer is ONLY for women with the BRCA gene .. is this true?! Also, MCH recently said in another podcast that ONLY women with current active breast cancer should not take mht, and that Every other woman, even those with family history and BRCA gene has no risk of breast cancer from mht … what the heck?! I realize the risk is low, but after going on mht about a month ago, it still sits in the back of my mind … that what if … how can some docs: influencers say there is No risk?!
This is incorrect. As in way in left field incorrect. There is absolutely a risk of breast cancer associated with combination hormone therapy (estrogen and a progestogen); this is the most common therapy that women will take. I have a post coming out this weekend looking at the risk in more detail. It is controversial whether estradiol alone has no risk of breast cancer; if it does, it is much less than when combined with a progestogen. Premarin is not associated with breast cancer when given by itself to women without a uterus.
Yes all that you have included in your response I have read. The study does state initiating estrogen therapy and teh percentage of risk for dementia is 4.8%. I also am aware of other things that can cause night sweats/hot flashes, thyroid issues are top of the list in my opinion. If the Menopause Society did not agree with the statement on page 5 of the study then my opinion is they should not include the information at all.
I am trying to determine if removing versus retaining the ovaries at the time of hysterectomy was ever evaluated as part of WHI. I have not seen this mentioned in any articles I have read. Could total lifetime estrogen exposure whether exogenous or from our own ovaries play a role in breast cancer? If ovaries were removed during hysterectomy, could the breast cancer risks be lower in the hysterectomy group due to lower lifetime estrogen/hormone risks especially when compared to in the uterus in situ group in combined HRT. Could a study be done evaluating breast cancer risks with Mirena IUD versus oral contraceptive pills that suppress ovulation (possibly lower endogenous hormones) as an alternative? We already know women who breastfeed more babies have lower risks of breast cancer. Could this also be true for hormone suppression that may occur during breastfeeding causing decreased risk of breast cancer?
This is a very clear explanation of the risks and benefits of hormonal therapy. I was on the fence, couldn’t decide for the longest time, and then frequently second-guessed my decision since my hysterectomy 10 years ago. It all seemed so confusing and complicated. I feel vindicated and relieved after reading this post.
Thank you for the invaluable service that you provide!
Thank you! Although to be clear this applies primarily to the regimens studied in the WHI.
Thank you so much for your voice…For analyzing all sides of the data to share with us and for calling out the cherry-picking that is often seen across social channels by other doctors. I was really persuaded by that initially and then very confused when I started reading the studies myself. I truly appreciate your insight.
The problem is not the study. The problem is that we are still relying on a 20+year old study because nobody wants to do any more research. If progesterone is the problem WHERE are the studies on using IUDs instead for instance?
The fact that we do not have more randomized clinical trials with other hormone regimens is a problem. Hopefully, this recent injection of funding will help us get some studies done. But as this is the big randomized trial that we have, it's important to use it correctly.
And they weren’t studying the micronized progesterone that is generally prescribed now, along with transdermal estrogen. I don’t understand how this study really translates to the current MHT types/delivery methods.
It is one of the few large randomized trials that we have and many people use it to promote MHT for disease prevention
thank you for this clear breakdown! It has been tough to decide, and what doesn't help is reading "experts" here on substack and socials talking about the WHI and all its roughly 15 re-analyses with the last largest one by the original authors themselves summarizing that 5 yrs. on estrogen therapy equals = “less” breast cancer, “less” death if you do get it, “less” recurrence, with “less” death if you do get a recurrence. I am not sure if you have already discussed the new article in Menopause (May 2024-Use of menopausal hormone therapy beyond age 65 years and its effects on women's health outcomes by types, routes, and doses). Same "experts" say that this 10 Million NIH/Medicare study showed that older women live longer (19% longer), healthier lives on estrogen replacement.
I already discussed the beyond 65 years article. It is a data base review and observational. Check out the past couple of posts. There is no WHI paper showing a lower rate of breast cancer with combination therapy or with Premarin alone at 5 years that I have seen and it’s not referenced in the 2022 NAMS guidelines. The Premarin results emerged after longer follow up. And with Premarin there is reduced breast cancer mortality. However the long term data presented in this review do not support MHT for disease prevention.
Wonderful synopsis, and I thank you. I'm not sure if I should keep taking my prescribed D and Calcium or not. It doesn't seem to be harming me (maybe some constipation), but I wouldn't want to take it for nothing either. I do have osteopenia.
Would love data and discussion of Vitamin D and calcium only for osteopenia. This choice does not seem to be the “slam dunk” it seems it should be, based on some studies I’ve read.
Great information thank you. If women were using transdermal only estrogen and discontinued it for a short time before 65 can it be resumed for persistent issues in your opinion after 65?
Wow! Kudos on this great analysis/summary!
When WHI first 'broke' (along w/ its fallout...) my immediate reaction was 'the pendulum will swing back again.' My 2nd was: 'what this study shows us is that you can't take a bunch of women, 10 yrs post-menop., half of whom smoke, and give them a progestin already known not to be cardio-friendly, and expect it to do any good.' And in the back of my mind was that monkey study (I know women aren't monkeys, but still...) that showed that waiting a while post menop. to give estrogen wasn't going to prevent/treat atherosclerosis.
Thanks
The new position statement released in January 2024 states in the conclusion if a woman over 65 wants to continue or start hormones the lowest dose is suggested as well as the route non oral as long as a medical history indicates it can be used. This is good news for all of us over 65 still suffering not just hot flashes (as estrogen is not just indicated for use for this purpose alone) but for the other issues we experience.
We do not recommend a new start over the age of 65 given the increased risk of dementia and cardiovascular disease
I would like to read more studies regarding the risk of dementia. I have only been able to access two current ones that were conducted in Europe. Also if a woman has no cardiac issues and suffers from hot flashes not related to another medical reason as well as osteoarthritis concerns would it not be up to that person to make an educated decision with her health care professional? If estrogen (in recent studies) has protective properties for those persons who are suffering why should it not be an option? The new Menopause society updated 2024 does not negate initiation of estrogen, if it is contraindicted why are they not stating that fact? Even one of the past presidents has released a new opinion on the use and initiation over 65.
I have not seen a new position statement from the Menopause Society from 2024, so I cannot speak to your source. The last position paper on hormone therapy from NAMS is from 2022. These 2022 guidelines quote the WHI Memory study, which indicates an additional 23 cases of dementia per year per 10,000 people who take hormones starting at age 65 and older. I can't answer your other questions, as those are questions between providers and patient. People and providers can certainly choose not to follow the guidelines, but that is not something I can address here.
I have the document saved if you would like to read it. Publish date January 2024 Menopause Society. In the Associations with CV and Dementia it states (also there are charts which display the statistics per # of persons, 10 million women) that "transdermal and vaginal ET which should avoid the procoagulant and proinflammatory effects ascribed to liver passage exhibited reduced risk of both dementia and stroke, in accord with the results of other studies". This statement also suggests that vaginal estrogen has more of a systemic impact then some physicians are aware of. Especially for those persons on thyroid replacement. As per my recent communication with Dr. A. Bianco (past president American thyroid Association) all forms of estrogen will impact thyroid medication which means it impacts TBG and a need for a dose increase of T4 is required. I do understand why you would not want to address what other providers are willing to prescribe. The original study Use of menopausal hormone therapy beyond age 65 years and its effects on women's health outcomes by types, routes and doses (Seo H. Baik, PhD, Fitsum Baye, MS, and Clement J. McDonald, MD). It is available in google scholar to download. I can also access it through Jama and the Menopause society website (which does need to be updated). As a university instructor I am able to access more current data as well as studies.
Please give me the name of the publication so I can look for it in Pubmed as it is not listed on the NAMS website nor in any of the emails that I have received from them, as I just went through my email to make sure I had not missed it. I did address the Baik paper in two posts here. This is the first one https://vajenda.substack.com/p/how-long-can-you-safely-take-menopause
I did notice that you mentioned some of the information in study.
full access of the article is available thought the website www.menopausejournal.com scroll through the latest publications. It is a lengthy study, but I like that it includes statistics.
portion of the information pubmed link
https://pubmed.ncbi.nlm.nih.gov/38595196/#:~:text=Results%3A%20Compared%20with%20never%20use,%2C%20lung%20cancer%20(13%25)%2C
https://www.menopause.org/docs/default-source/press-release/use-of-ht-beyond-age-65-and-its-effects-by-type.pdf
another one from former NAMS April 2024
Since the study has been accepted and published by the Menopause Society (formally NAMS) and states "The Menopause Society changed their postion about the use of HT in women aged 65 and older, suggesting that the decision to start or continue HT beyond age 65 years should be individulaized (ie, based on the individual's specific needs, overall health, and medical history) and highlighted the use of lower doses and nonoral preparation to minimize risks of adverse effects" (Seo H. Baik et al). I as well as many women should be advised of this data to make an informed decision.
The paper you are quoting concerns continuing MHT beyond age 65, not starting. They are not the same thing. In the 2022 guidelines, the Menopause Society changed the recommendation about routine stopping at age 65. Here is the entire quote about starting past age 60 from the Menopause Society Guidelines: Initiation of hormone therapy in women aged older than 60 years or more than 10 years from menopause onset has complex
risks and requires careful consideration, recognizing that there may be well-counseled women aged older than 60 years who choose to initiate or restart hormone therapy. For women
requesting to initiate hormone therapy because of VMS appearing many years after menopause onset, further evaluation is needed. Although new-onset VMS in an older woman could be caused by estrogen-deficiency, hot flashes or night sweats may be related to an underlying medical problem (eg, obstructive sleep apnea, hyperthyroidism, carcinoid, lymphoma, Lyme disease, tuberculosis, HIV) or medication or substance use
(eg, antidepressants, antidepressants, hypoglycemic agents, or withdrawal from
alcohol or opioids). Throughout the piece they mention several times the increased risk of dementia seen with starting at age 65 or older from the WHI. Regarding continuing past age 65, here is an excerpt: Of note, the continued use of hormone therapy in healthy women aged older than 65 years at low risk for breast cancer and CVD is limited by insufficient evidence regarding safety, risks, and benefits. For otherwise healthy women with persistent VMS, continuing hormone therapy beyond age 65 years is a reasonable option with appropriate counseling, regular assessment of risks and benefits, and shared decision-making. Hormone therapy also may be considered for prevention of fracture in healthy older women at elevated fracture risk when bothersome VMS persist or when hormone therapy remains the best choice because of lack of efficacy or intolerance of other fracture-prevention therapies.
Long-duration hormone therapy use and use in older women is not appropriate for reduction in the risk of CHD or dementia. When providing hormone therapy to older women, clinicians must remain vigilant about risk stratification and potential mitigation strategies, such as switching from oral to transdermal hormone therapy, choice of progestogen, and lowering of dose.
These conversations cannot happen here online, they must occur in a doctor's office. And of course people should know that in the WHI those who started hormones over age 70 for hot flashes had a 500% increase in cardiac disease. Of course that is oral therapy, but it is important information. In addition the risk of breast cancer does increase with duration. Al of these things are to be discussed and then individual patients and providers can come to decisions that work for them.
Thanks for your very thorough explanation.
Question: For those of us that did start HRT before the age of 60 and are now approaching the age of 65, does the report suggest we should stop taking HRT once we reach 65?
No, this has nothing to do with continuing hormones that you are already taking. This might help you there https://vajenda.substack.com/p/how-long-can-you-safely-take-menopause-6e8
Wow! 🤯 first time REALLY understanding this study. I had always heard the msg (from other MDs as well on podcasts etc) that study was all bad. Now: Mht is all good. Especially the new msg that mht is a wonder disease prevention. I appreciate the detail written here- thank you as always!!
Yes, there is a weird "MHT has zero risks and is the cure for longevity" message that is permeating social media, and a lot of it is based on this study, I believe, but that would not be a correct position. So, it's important to set the record straight. There are risks with MHT, more so with combination therapy. Most people would consider those risks worth it for treatment of hot flashes or night sweats of depression in the menopause transition.
Thank you for this thorough review! My mother always said she couldn't get MHT because of her risk for blood clots and just suffered through the symptoms for decades. I wonder if this means she could have actually taken it to reduce her symptoms?
Hard to know. It would depend on what her risk for clots actually was.
It's why women my age group (68) are furious. Doctors would not subscribe any hormones and they took their women patients off any and all hormones. I was the only one that refused to go off estradial. I had my uterus and ovaries removed at 50. I had to shop for a doctor, do annual mammograms, get my arteries scanned, etc. As she said we have a right to be EXTREMELY angry. My friends all gained 20-40 lbs and suffered many sleepless nights. It's been more than 10 years since their last period, so they can not get estrogens prescribed. A whole generation of women continue to suffer. Knowing that it is because the study was misinterpreted and reported does NOT help. It actually makes me madder.
This is so helpful, thank you. I am super curious about the HT cancer risks for non-drinkers (of alcohol) vs. moderate drinkers. Do you know of any information out there?
wondering if there is any research on knowing where is a good place to apply estradiol gel. Knowing there are many estrogen receptors on or shoulders neck and hip areas. is it coincidence that many althralgias occur in these places for women that are premenopausal and post menopausal? would it placebo to think shoulder pain has dissipated after applying gel to shoulders for several days?
You should only apply it where the product insert advises. Never apply it anywhere else as that can affect absorption.
is there any research on this i have been struggling with pain in my shoulders post frozen shoulder and thought i would try it after 2 applications it was gone… so crazy
the pain has been there 2 years
A friend who follows Peter Attia is convinced that the risk of breast cancer is ONLY for women with the BRCA gene .. is this true?! Also, MCH recently said in another podcast that ONLY women with current active breast cancer should not take mht, and that Every other woman, even those with family history and BRCA gene has no risk of breast cancer from mht … what the heck?! I realize the risk is low, but after going on mht about a month ago, it still sits in the back of my mind … that what if … how can some docs: influencers say there is No risk?!
This is incorrect. As in way in left field incorrect. There is absolutely a risk of breast cancer associated with combination hormone therapy (estrogen and a progestogen); this is the most common therapy that women will take. I have a post coming out this weekend looking at the risk in more detail. It is controversial whether estradiol alone has no risk of breast cancer; if it does, it is much less than when combined with a progestogen. Premarin is not associated with breast cancer when given by itself to women without a uterus.
Yes all that you have included in your response I have read. The study does state initiating estrogen therapy and teh percentage of risk for dementia is 4.8%. I also am aware of other things that can cause night sweats/hot flashes, thyroid issues are top of the list in my opinion. If the Menopause Society did not agree with the statement on page 5 of the study then my opinion is they should not include the information at all.
I am trying to determine if removing versus retaining the ovaries at the time of hysterectomy was ever evaluated as part of WHI. I have not seen this mentioned in any articles I have read. Could total lifetime estrogen exposure whether exogenous or from our own ovaries play a role in breast cancer? If ovaries were removed during hysterectomy, could the breast cancer risks be lower in the hysterectomy group due to lower lifetime estrogen/hormone risks especially when compared to in the uterus in situ group in combined HRT. Could a study be done evaluating breast cancer risks with Mirena IUD versus oral contraceptive pills that suppress ovulation (possibly lower endogenous hormones) as an alternative? We already know women who breastfeed more babies have lower risks of breast cancer. Could this also be true for hormone suppression that may occur during breastfeeding causing decreased risk of breast cancer?