The beauty of science is that it is a continuum. There are hypotheses, theories, experiments, research and happy accidents. Guidelines and practice are based on the best knowledge and date available. With the continuum of science and ever changing technology, sometimes what we thought was best gets proven to be otherwise.As Maya Angelou said, “Do the best you can until you know better. Then when you know better, do better.”
There are so many examples of this. As I binge watch Call the Midwife, fresh in my mind is the man-made disaster of thalidomide. This was the medication given to pregnant women the the 1950's and 1960's to ease nausea. It was later linked to disastrous outcomes of increased numbers of miscarriages, birth defects and babies born with phocomelia (flipper-like limbs). As soon as research and data showed this, thalidomide was banned from use.
Less drastic is the research and data surrounding estrogen use in women and the link to breast cancer. Many of us can remember the fear back in the 1900s (1990s, eyeroll) of taking estrogen in any form would drastically increase one's chance of developing breast cancer. These thoughts were derived from the Women's Health Initiative Study (1991) and the Million Women Study (1996-2001). The published findings led to a dramatic decreased in women seeking perimenopausal and menopausal relief through hormone replacement therapy.
Newer research is disproving the Million Women Study. An article by Natrajan, Soumakis and Gabrell, published in 1999, outlined their research and found that there was no causation or correlation between estrogen replacement in women who previously had breast cancer and recurrence of breast cancer or mortality rates. They also found that progesterone may even decrease the chance of recurrence.
Hodis and Mack published in The Cancer Journal in 2022 that HRT-associated risks (breast cancer, stroke and venous thromboembolism) are rare. They point out that these risks are not unique to hormone replacement therapy. Hodis and Mack also point to hormone replacement therapy helps to prevent cardiovascular disease and other aging-related disease.
The etiology of breast cancer is rather complex. If it were completely understood, one would think we could eradicate it or at least have a guaranteed treatment. We do know that the most current research shows that hormone replacement therapy does not cause breast cancer.
Today's women who experienced the 1990s are the same women who are experiencing perimenopausal and menopausal symptoms now. It may take another generation to fully accept the newer research debunking HRT causing breast cancer, as the fear that was placed in the 1990s was real. Fortunately, there are forms of estrogen that are less systemically absorbed and can help with some symptoms.
Sure, estrogen is commonly thought of a sex hormone that helps to regulate female reproduction and secondary sex characteristics. Yes, as it decreases, it contributes to those unbearable hot flashes and vaginal dryness that can make intercourse painful or increase urinary tract infections. Estrogen is also an important factor for protecting cardiovascular health and cognitive function. There is ongoing research studying the depletion of estrogen as it related to dementia and Alzheimer's. It is also a hormone that helps to maintain bone density and decrease the risk of developing osteoporosis.
As women celebrate more birthdays, their testosterone also decreases. Replacing it can help restore fun things like libido, sex drive and overall energy. Sufficient testosterone levels are also necessary for maintaining and building muscle mass and also strong bones. It helps to maintain cognition and eliminate "brain fog".
A woman with an intact uterus taking an estrogen replacement must also take progesterone. Progesterone permits the uterine lining from building up to concerning levels. Progesterone also helps with mood stabilization, calmness and can even promote sleep. (pssst take it at night, before bed.)
For women who prefer not having to remember a pill every day, pellets are an excellent option. In fairness, they are not FDA approved. However, pellets have been around since the 1930s and have been well studied. Other forms of HRT:
- patch
- IUD
- cream/lotion/gel
- pill
- injectable
- vaginal suppository
Not every MD/DO/NP/PA is familiar with HRT therapy options or the more recent research. If you find this is an issue, that's why places like ATH exist! If you're in our area, we're happy to see you in consultation and answer your questions. If you're not in our area, we strongly encourage you to seek out a medical professional who has done extra training and education in HRT. Protect your health and longevity.
Oh! Were you wondering what a "happy accident" in science was? One example... Penicillin!
- Estrogen replacement therapy in women with previous breast cancer
Comments
Post a Comment