Hormone Therapy – Women's Mid-Life Health Program

Your questions, answered.

We have gathered a list of the most common questions women ask regarding topics that affect your overall health and well-being.

Hormone Therapy and Breast Cancer risk was addressed in the Menopause and Osteoporosis Update, 2009, Society of Obstetricians and Gynaecologists of Canada. They recognized an increased risk of breast cancer detection after 5 years of estrogen/progesterone therapy. The risk of breast cancer returns to normal shortly after stopping hormone therapy. “The short term use of HT for relief of disruptive vasomotor symptoms (hot flashed/night sweats) carries very little appreciable risk for the average woman entering menopause.”(1).

S.E. Singletary (scientific author) tried to put various breast cancer risk factors into perspective. He noted increased risk rates are about the same for women who:

Starting menstruating before age 12 (early menarche)
Reached menopause late (after 55)
Became obese after reaching menopause
Delayed their first pregnancy until after 30
Chose not to breastfeed
Did not exercise daily (2)
Consumed excessive alcohol

A recent study, called the E3N cohort study, showed that various forms of HRT have different risks. They found that the type of progester- one makes a difference. 80,377 post-menopausal women were followed for 8.1 years. There were 3,354 cases of cancer. Estrogen plus progesterone, estrogen alone and estrogen plus dydrogesterone had no increase in breast cancer. Estrogen plus other progestagens had a relative risk of 1.69. (3)

You will need to discuss your unique set of risks of breast cancer and benefits of HT with your physician or nurse practitioner. Informed decisions are always the best.

(1) Reid, R.L., Blake,J., Abramson,B., Khan,A., Senikas, V., Forier,M. (2009). Menopause and Osteoporosis Update 2009 [Electronic Version]. Journal of Obstetrics and Gynaecology Canada, 33, S19

(2) Reid, R.L., et al S19

(3) Fournier, A., Berrino, F., Clavel-Chapelon, F. (2007). Unequal risks for breast cancer associated with different hormone replacement therapies: results form the E3N Cohort study. Breast Cancer Research and Treatment (2008) 107:103-111.

The question of HT safety is complex and has a complex answer. * An informed decision about how to relieve symptoms of menopause includes understanding the risks and benefits of all the potential treatments: hormone therapies; other prescription therapies; complementary or alternative medicine (CAM) therapies; and lifestyle strategies. Another option is to do nothing at all and let the symptoms take their natural course.

The HT Decision is Unique to Each Woman; One Size Does Not Fit All.

Cause of your symptoms
Your preferences
Disease risk factors with and without HT
Your age
Cost of treatment options
How much your symptoms affect your quality of life

Known or suspected breast cancer
Known or suspected estrogen-dependent or progesterone dependent neoplasia (a growth that may or may not be cancer)
Serious heart, liver or kidney disease
Unexplained vaginal bleeding (once the cause has been found and treated, HT maybe appropriate)
Active or a history of blood clots or abnormal blood-clotting
Active or recent stroke or heart attack

A number of side effects are associated with HT and these may depend on how the HT is taken (oral, topical patch, gel or cream), the type of hormone and the dose.

Common side-effects such as nausea, headache and breast tenderness can be felt when HT is started but will decrease over time. If they do not go away, switching to a different type of hormone, changing dose or how it is delivered (oral/topical) will often eliminate the side effect.

Weight gain is NOT a side effect of HT! Sad but true, weight gain is commonly the result of diet, physical activity and metabolism changes. Talk to your health care provider about weight gain and what you can do about this.

Bioidentical hormones (HT) are hormones that are chemically identical to the hormones produced by women (primarily in the ovaries) during the reproductive years. Some hormones that a woman’s body makes include various estrogens (17 estradiol, estrone, estriol) as well as progesterone, testosterone and others. Bioidentical hormone therapy (HT) means a medication provides one or more of these hormones as the active ingredient.

Some bioidentical hormones are available in well-tested, government approved, brand name prescription drugs, such as some oral, patch and gel preparations. Here are the different types of bioidentical hormones:

Bio-identical estrogens (plant source)
Estrace - micronized estradiol - 17 estradiol, oral
Estraderm patch, Estradot patch - both are 17 estradiol
Estrogel topical gel
Biest cream, compounded estrogens (estriol and estradiol)
Vaginal estrogens: Vagifem vaginal tablet, Estring vaginal ring

Bioidentical Progesterone: (plant source) Micronized progesterone – Prometrium oral, or custom compounded oral progeaterone Progesterone cream, compounded (lack data on absorption, serum levels, efficacy)

Custom-Compounded Formulations can be made by a pharmacist specially trained in the preparation of these products. Products can be prepared without additives such as binders, fillers, dyes, preservatives or adhesives that are found in patented, commercially avail- able products. Compounding also allows for different methods to administer hormones. There are several compounding pharma- cists in Saskatchewan.

It is not recommended to purchase unregulated products over the internet as safety and effectiveness of product cannot be guaranteed.

Sources: Menopause Practice, a clinicians guide, 3rd Edition, North American Menopause Society, 2007 The Hormone Survival Guide for Perimenopuase, Nisha Jackson, Ph.D., 2004

The current recommendation of the North American Menopause Society is that HT be used for as short a time as necessary to control hot flashes (vasomotor symptoms), sleep disturbance, vaginal dryness, painful intercourse, and vaginal aging.

The goal of HT is to use the least amount of estrogen (with or without progesterone) to reduce your symptoms. The dose and how long it is taken will depend on each woman’s risks, benefits and her response to the therapy. Determining the most appropriate dose may take some time and should be evaluated regularly until you find the right dose for you. Once that is found, it is recommended that you review your HT with your doctor every year at your annual physical.

This should be done in consultation with your doctor. The recommended way to stop taking your estrogen is by gradually tapering over several months.

If you start getting increased hot flashes or night sweats while you are lowering your dose of estrogen, go back up to the level of estrogen at which hot flashes were totally gone. Maintain that dose for several weeks longer before beginning to gradually reduce the dose again.

To see outlines of sample patterns of taping off HT, go to
Dr. Jerilynn Prior MD’s website at
www.cemcor.ubc.ca/help_yourself/ articles/stopping_estrogen

Dr. Prior is the Scientific Director for The Centre for Menstrual Cycle and Ovulation Research at the University of British Columbia.