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Does Hormone Replacement Therapy Cause Cancer?

Writer's picture: juliagranackijuliagranacki

Does Hormone Replacement Therapy cause cancer?


The answer without question is no.  Does it increase the risk?  That answer is nuanced. 


There is a lot of information and misinformation about the topic, and unfortunately, it’s possible that even your healthcare provider is not aware of what is what. It’s hard to know where to turn and who to get your information from.


As a Women's Health Coach specializing in menopause and perimenopause, I have to stay diligent and vigilant about the latest data regarding Hormone Replacement Therapy (HRT), also known as Menopause Hormone Therapy (MHT). 


But when my own healthcare provider is poorly informed and feeding me incorrect or outdated information, I admit that even I am susceptible to being gaslit.  


For the past three years, I have been getting my annual mammogram and ultrasound (I have dense breasts, so I’ve always gotten an ultrasound in addition to my regular scan) at a local breast center in New Jersey.  I initially started going there because of ongoing breast pain that would later turn out to be muscular (pectoral) and not breast.  That is another story for another time, but I needed a specialist since other providers couldn’t tell me the root of the pain.


The facility was a one-stop shop; all the equipment (including an MRI room) was on the premises. A doctor read your scans after the procedure, followed by a breast exam, and all results were given immediately. I liked the place. The administrative staff was personable, the technicians were friendly and competent, and it was incredibly convenient.


What I didn’t like was constantly being on the defensive about my use of HRT.


It started with my initial consultation where the doctor asked me why, instead of taking micronized progesterone at night, I didn’t “...just take a sedative?”  I had to explain that I had tried sedative-hypnotics like Ambien and Belsorma and benzodiazepines like Klonopin and Xanax, and not only were these highly addictive substances and not tenable for long-term use, but they didn’t work well for me. Micronized progesterone, on the other hand, had solved years worth of sleep issues in a matter of a few weeks, and it was extremely safe and non-habit forming.  


Unfortunately, it didn’t end there.  Enter the Physician’s Assistant (PA) assigned to me for my manual breast exam.  We’ll call her Ruby.  Ruby was the person I spent the most time with since she would go through my chart, ask me medical questions, and make small talk as she did the exam.  Over the past three years, she has said several baseless things to me which (were I not who I am) I might have taken as gospel because she’s a medical professional; she knows everything, right?


When we first met, she told me I couldn’t be on HRT for more than ten years and shamed me for being on it in the first place because it was a “natural” transition.  At that same appointment, she told me women shouldn’t be on the oral birth control pill for more than 15 years.  She said several other things I found offensive because of their inaccuracy, which I don't have time to list in this (already) lengthy blog post. Still, while I knew all these things to be untrue, I doubted my knowledge.


At that point, I had only been coaching for about a year, and Circling the Drain Podcast was only a few months old.   This was also before menopause started having a moment—before Naomi Watts and Stripes before Stacy London became the community’s mouthpiece, and before Heather Corinna’s seminal book on the matter, What Fresh Hell is This?


Another year went by, and with my new appointment, I would gird my loins and mentally and emotionally prepare for whatever wild sh*t might come out of this woman’s mouth.  On more than one occasion, I considered taking my breast care elsewhere, but I’m a sucker for convenience and efficiency, and this place had that in spades.  Plus, it was just once a year, right?  So I kept the appointment, ignored Ruby’s words, and continued with my life.


It wasn’t until my annual mammogram this past May that I had finally had enough. 


I had now been coaching on perimenopause and menopause for three years; we had several renowned specialists on the CTD podcast, and data on the safety and efficacy of HRT was emerging in real-time daily.


Most recently, the internet was a flutter with the earth-shattering news that not only did estrogen therapy (alone) not increase the risk of breast cancer, but it DECREASED the risk. This was such a win!


I was more experienced, intelligent, and confident.


Still, I again prepared myself mentally for my visit.  I completed my mammogram and ultrasound, and everything was clear.  Then came my breast exam with Ruby, and to my surprise, other than asking me some basic medical questions, making small talk, and making sure I was taking vitamin D (Why? Of all the things?), she didn’t mention anything about my HRT use.  


What a relief!


But.  I spoke too soon.


As I left the examination room and walked down the hallway past her office, she called out a name (not mine). I looked back, confused, and she said, “Oh’, I mean Julia.”  I walked back to her office, paused in her doorway, and found her sitting at her desk.


“You’re still on HRT, right?”  


“Yup,”  I said.


“Oh’ well, then you also need an MRI.”


“I just had one two years ago, and we resolved the breast pain issue, so I’m fine,”  I said.


“If you’re on HRT, you need to get an MRI every other year.  Also, you can’t be on it for more than five years.”


HUH.  So. Two years ago, it was ten years, and now it’s five?


I looked at her, perplexed, and said, “I don’t think that’s true, so I’m not going to do that, but thank you.”


I was polite and firm and walked away, but I was annoyed, fed up, and deeply concerned about what she might be telling her other patients! 


She called me no sooner than I sat in my car seat and started the engine.  I did not pick up.  She left a message saying (to paraphrase), “...I know we were discussing in the hallway about the estrogen…but I’ll send you an article, and please call me back to discuss.”


When I got home and started to work on some Pilates class planning, I saw her email:  


Hey Julia,


I know we spoke in the hall before you leaving about HRT. Sorry probably should have discussed it in the room, my apologies.   I just wanted to clarify that the new research is regarding estrogen alone.  Not estrogen and progesterone.  


Newer research is suggesting estrogen alone may be beneficial, not estrogen and progesterone. 


I have not been able to find any new research saying estrogen and progesterone does not increase the risk for breast cancer.  The only research we have says there is increased risk when taken for more than 5 years. 


Feel free to call me to discuss. 


I included information from the FORCE website which I thought was good.


I was livid. 


Firstly, we should establish that if you have a uterus, you must take progesterone as it protects your womb from cancer (a progesterone IUD also works). The only folks who can take estrogen-only therapy are those who have had a hysterectomy.


While FORCE is a reputable organization whose mission is to “...improve the lives of the millions of individuals and families facing hereditary breast, ovarian, pancreatic, prostate, colorectal and endometrial cancers”, it is not the first place that I would go for the latest research and guidelines on HRT use.  For that, I would go to The North American Menopause Society (NAMS).


Here is where I want to convey the importance of seeing a menopause specialist, ideally one certified by NAMS, for your perimenopause and menopause care.  


While the FORCE article was correct in a general sense, proper interpretation of the data matters, and Ruby completely missed those details because she is not trained in perimenopause and menopause care or the use of Hormone Replacement Therapy.


It took me over a week to respond to that email because I needed to get past my anger and verify information with reputable resources like my Menopause Specialist at The Center for Midlife Health & Menopause at NY Langone.  


I confirmed that even with a distant family history of breast cancer (two great aunts on my mother’s side), I was still considered low-risk.  Furthermore, my mother and I were both tested for genetic markers and cleared. Ruby knew this.  


My specialist also thought that a breast MRI based on the sole reason for HRT use was outrageous.  She then confirmed that micronized progesterone does not increase the risk of breast cancer.  It’s progestins (more specifically, medroxyprogesterone acetate), a synthetic form of progesterone sometimes used in HRT, but often found in the oral birth control pill and contraceptive injections like Dep-Provera.


As a side note, the birth control pill has a nuclear bomb size amount of hormones so big that it tricks your body into thinking it’s pregnant, halting ovulation.  Despite that, the BC pill is not treated with the fear-mongering that HRT has attracted over the years.  In fact, according to Medical News Today, the oral BC pill increases breast cancer by as much as 29%.


I don't tell you this to scare you away from the BC pill, as I think it's incredibly beneficial for a lot of women. I'm telling you this to give you context. Prescription HRT is not administered at the high level of the BC pill. Not only that, the HRT you're prescribed will never be as high as the natural level you had during your most fertile years. The dose is low.


Regarding the length of time on HRT, researchers have found that timing (within ten years of menopause), dose, and type of HRT matter. According to the Menopause Journal (North American Menopause Society), age or length of time on HRT use should not be a reason to discontinue HRT. 


My mother has been on it for more than 20 years.


While menopause is natural, it isn’t smooth sailing for all women and can have negative life-altering consequences.  I've had a few post-menopausal women say something like, "I don't get it. My menopause was fine; I didn't have any problems. I rubbed some tea tree oil on my wrists if I got hot. It's natural; just let it happen!"


To which I always say, "Good for you!" I mean that in a sincere, non-condescending way. Sort of.


But seriously, any woman who goes through this transition with little to no symptoms is lucky because the statistics tell us that this is rare. 74% of women said at least one symptom of menopause, primarily hot flashes and night sweats, was disruptive to their lives, and according to a survey conducted by the National Association of Female Executives, almost half of the women (45%) noted that menopause symptoms were worse than they expected.


AND - know what else is natural?  Erectile dysfunction, but you don’t see men being told that it’s natural and they should "tough it out." 


The "natural, tough it out" take on menopause is highly patriarchal in its reasoning, and I think it's wild that some women don't see that. I have the same opinion on IUD insertion, but don't get me started!!


Having options and choices for treatment is what matters.


You can read Dr. Mary Claire Haver's better-articulated take on all this here, in response to this tone-deaf garbage article published in the Lancet.


Read both. It’s worth it.


Hormone Replacement Therapy does not cause cancer, and increased risk depends on patient history, type of HRT, and the window in which it is prescribed. 


Like any medication, it comes with risk.  As I wrote at the close of my response to Ruby: 


A risk/benefit analysis should be done with the patient and a menopause specialist—preferably someone certified by NAMS. 


While I believe you have the best intentions, you are not a specialist. 


If you are having difficulty managing perimenopausal symptoms, you can do something about it. Don't let fear prevent you from seeking treatment. You deserve to feel better!


For the best explanation I have ever seen on how breast cancer actually works, check out this post by Dr. Amy Killen here.  


If you’d like to calculate your risk of breast cancer, you can do so at the National Cancer Institute here


If you’re interested in HRT and other treatments for symptoms of perimenopause and menopause, you can find a certified menopause specialist near you on the NAMS website here.


If you’re unsure where to begin, schedule your free intro Zoom session with me here!


This blog offers general information about health and related topics. The information and other content provided in this blog, website, or any linked materials are not a substitute for medical advice, diagnosis, or treatment. If you have a medical concern, please consult your healthcare provider or seek professional medical treatment immediately.

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