Posts Tagged ‘Estrogen’


Knowing All the Facts About the New HRT Study

Friday, October 22nd, 2010

The single largest barrier to women taking ET/HT and allowing themselves to feel better after menopause is the fear of breast cancer.  Informed physicians can’t just sit by and allow the media to get this important story wrong.

The study just released regarding hormone replacement therapy (HRT) and breast cancer released October 20th (from WHI group Chlebowski et al) has been met with fearful reactions by the news media, but what can we learn from this new study? For one thing, the absolute risk is exactly what we knew from before. There is a .008% increase risk for a breast cancer diagnosis with an increase risk of death from breast cancer of a .012%. These are very tiny individual risks. 

The new information is in the details of breast cancer cell types associated with Medroxyprogesterone Acetate (MPA, the progestin found in Prempro), and the incidence of higher death rates. The problem remains with MPA. The estrogen alone trial of the WHI study showed a 23% decreased risk if being diagnosed with breast cancer.

As of today we even have very reassuring data about estradiol and natural progesterone not statistically increasing risk for breast cancer and also showing much better survival if one does get a breast cancer diagnosis if the woman is on estradiol at the time of diagnosis. The detail of which hormones a woman takes is very important. We must help make women aware of news about different products that does not relate to their risk status, unless they choose to be on Prempro for 11+ years.

I have never given any age of a woman a Premarin or PremPro prescription for a new start of hormone replacement therapy for the management of menopausal symptoms. There are many better options and that is the bottom line for this article as well. Simply look at transdermal estrogens, all biologically identical to that which we naturally make in our bodies and for which nature selected over millions of “randomized blinded trial years” (the process of natural selection at its finest in my opinion). In all sorts of research, at cellular levels, as well as gene regulation and gene suppressions/expression studies, estradiol is very positive in its effects on cell differentiation; in essence, keeping healthy breast cells healthy. That is the goal of ideal hormone support for every tissue we study: the enhancement of balanced regulated cell growth and positive anti-oxidant effects of estradiol.

Letter to Editor in response to Kantrowitz and Wingert (Newsweek 3/1/2010)

Tuesday, March 9th, 2010

As a women’s health physician, breast cancer advocate and author, it’s time we get solid information that encourages hormonal harmony, and doesn’t fan the flames of ill founded fear. Kantrowitz and Wingert offer us an erroneous cancer scare, an old theory recycled, contributing nothing of value. Women are victims of scare campaigns about breast cancer which are doing us harm. As noted in their article, invasive breast cancer rates started dropping in 1999, thanks to more regular mammogram screening, and other factors, some known and others undiscovered. This observed decrease was more than 3 years before women bolted from their hormone replacement therapy (HRT) due to exaggerated (and now we know, wrong) reports about breast cancer rates and estrogen use in menopause. To their detriment women have continued to decrease hormone use annually since the 2002 WHI reports, yet breast cancer rates have not continued to decrease. And in Holland (one of many examples) similar decreases in hormone use are not associated with any decrease in breast cancer incidence. Not exactly a validated hunch.

In fact the 2007 data from the Women’s Health Initiative, the WHI (the largest American study of thousands of menopausal women on PremPro® or Premarin® alone compared to placebo) when analyzed and corrected to reflect disease occurrence in those women who actually took the study pills, revealed no significant difference in rates of breast cancer between the women who took Premarin© and those who took the dummy pills. After 7+ years of taking estrogen-alone, estrogen users had 17% less breast cancer compared to women who took a sugar pill. And these estrogen-alone users wisely continue to take their pills to a much greater degree than the women on the combination therapy, PremPro and others like it. These confident women continuing on their estrogen contribute to the lower rates of breast cancer documented.

And what about the statistic that everyone agrees with? Cancer specialists, radiologists and primary care docs all know that women who are diagnosed with breast cancer while taking estrogen fair a lot better. This is a very significant effect when you look at death rates from breast cancer. Since 2000 most studies of women on estrogen show they have a lower risk of being diagnosed with breast cancer, especially if those with a uterus use bioidentical progesterone along with it. This is the most important information we have today if we are to decrease suffering with this all too common disease.

It is time we got it straight about estrogen NOT being the bad guy when it comes to breast cancer. In addition to lowering breast cancer death rates, estrogen has many positive preventive effects when begun for symptom relief during early menopause. Early estrogen therapy lowers the risks of heart disease, osteoporosis, colon cancer and dementia, as well as lowering breast cancer deaths. These are big benefits that are left out of the fear-engendering mis-information that keeps getting recycled. Taken correctly, estrogen offers a watermelon size benefit and a watermelon seed size risk.

Yours sincerely,
Ricki Pollycove, MD, MS
Author, “The Pocket Idiot’s Guide to Bioidentical Hormones,” 2010, Alpha Press
Founding Director for Breast Health CPMC Breast Center
FACOG, NAMS CMP, ASBD and SFMS member