Chief Medical Officer of BodyLogicMD, Dr. Jennifer Landa responds to the recent NY Times article, discussing the benefits of estrogen hormone therapies in menopausal and post-menopasual women.
Here is another part of the story from the famed Women’s Health Initiative (WHI) trials which were prematurely discontinued when it was found that women using a combination of conjugated equine estrogens (CEE) and the progestin, medroxyprogesterone acetate (MPA) increased the likelihood of breast cancer and heart disease. This new report is exciting because it actually highlights some of the good news about hormone replacement therapy. The new findings are based on a group of women who were able to continue the WHI study. These were women who had undergone hysterectomy prior to participating in the study. Because these women do not have a uterus intact, it was presumed safe for them to take conjugated estrogens alone (without MPA). Estrogen, when taken by itself, without a progestin or progesterone component in women who have not undergone a hysterectomy can increase their risk of developing uterine cancer.
The women in this arm of the study were able to continue the study after the women in the combination CEE/MPA arm of the study stopped taking the medication. The women in this group were able to continue because there weren’t any risks of breast cancer or heart disease for the women in the estrogen (CEE) only group. These women have been followed for a total of 11 years now. The new findings were surprising. The study revealed that the women who took CEE-only had a significantly lower risk of breast cancer and heart disease. The decreased heart disease risk was really only true for younger women who started taking estrogens closer to age 50.
This study again highlights the differences between different hormones and the dangers in statements like, “all hormones are alike and have the same risks and benefits.” Clearly it is more complicated than that. This data once again confirms the dangers of progestins, particularly MPA when combined with estrogen. The New York Times article points out that nearly one-third of women in their 50’s have undergone hysterectomy. This data is useful for them but what about the other two-thirds of women? The good news is that the women with a uterus could take progesterone (the same exact hormone that protected their uterus from estrogen prior to menopause — bioidentical progesterone) to protect their uterine lining from the thickening cancerous effects of estrogen when used alone. Progesterone when combined with estrogen does not increase the risk of uterine cancer, breast cancer or heart disease..
These results are exciting in the world of hormones because it causes us to look once again at the fact that not all hormones or all women are the same and a one size fits all approach isn’t practical when it comes to hormonal balance. We must look at the patient’s symptoms, age and medical history and decide whether hormones are appropriate and precisely which hormones would have the yield the most benefits with the least amount of side effects. This study again shows that not all hormones are bad in the way that many people believe them to be and that they are actually beneficial when taken properly.