Ask Dr. Jen
Another important consideration from the WHI is that the decrease in colon cancer more than made up for the increase in breast cancer. We all have to die of something. Hormone replacement improves quality of life and in terms of all cause mortality is probably a wash
Thank you so much, Dr. Jen. Distilling all the information/studies out there is exactly what I needed to help me understand breast cancer risk. I have dense breast tissue, and while I don't think there are any specific studies looking at that with MHT, since I think 50% of women have dense breast tissue, the data you've analyzed from these studies is very helpful. I'm 50 and on just .025 estrogen (patch) + daily oral progesterone for hot flashes, but I'm hoping to be on it for the long haul because of osteoporosis concerns, so I'm really looking forward to your piece on longterm MHT...
This is wonderful, thank you! I am confused about progesterone and the withdrawal bleed; my understanding of what you just wrote is that the progesterone means you will bleed, shedding the lining that leads to increased risk of cancer. But leaflets I've read (I'll find them shortly) say you *may* have a withdrawal bleed, and if you don't, no biggie. Sounds like a biggie to me! If you aren't bleeding a few days after you stop the progesterone pills (or if you have a mirena and don't bleed at all), isn't that potentially cancerous lining just growing unabated? Or have I misunderstood your post?
I am wondering for a future article if there might be something on why localized estrogen in the vagina (ie. Vagifem) doesn't pose the same risks, or does it? I was prescribed this product but haven't taken it yet largely because the production information sheet "screams" cancer. Thank you.
Thank you for this, I've been trying to get a good answer to this question and it's not easy. I'd like to add one variable--does your advice remain the same in a woman who has had a successful ablation with zero bleeding for 10 years?
If so (I'm assuming yes), I would like to try the patch but worry about the amount of swimming and exercising I do, and maybe oral would be better? Thank you!
Thank you so much for this! I have read the article several times and am a little confused. In the "however" section, you state "... we can’t really cherry pick and ignore what the observational data has to say about the breast cancer risk with estradiol given without progesterone/progestin." What is it that the observational data says about the cancer risk with estradiol without progesterone? I am currently on estrogen patch only, post-hysterectomy, but am thinking about going back on progesterone for mood/sleep/anxiety. Up above you state "there was enough data to suggest that using estradiol with progesterone did not increase the risk of breast cancer compared with women who didn’t take hormones." Are you saying that there is possible LESS risk of breast cancer with estradiol/micronized progesterone compared to estradiol along? Just making sure I am reading all of this correctly. Thanks again!!!
Thank you for another fascinating article.
In your upcoming piece about not starting hormones after 60 and/or 10 years after FMP, I wonder if you might be able to answer a question for me? What is the situation if your FMP doesn't happen until age 60 (this was the case with my mother, so I'm curious in case the same is true for me). Would MHT for a 60-year-old who has only just reached menopause be contra-indicated, or does the 10-year clock still start at that point?
Thank you so much for all the education!
Thanks for another great post.
I am perimenopausal and use only the estrogen patches because I can’t tolerate the negative psychological side effects of progesterone. I have been up using the patches alone for 4 months or so and in the last month I’ve bled twice and heavily. (Prior to that I’d been getting my period every two months.) I never thought that the estrogen could be the culprit, but now it makes sense. The patches help with heart palpitations and hot flashes, but strangely I think they increase sweating. I’m weighing whether to have a hysterectomy but I worry about the sudden drop in hormones on my mental health.