We wouldn't blame you if the latest round of horror story headlines about hormone therapy (HT) and breast cancer inspired you to flush your pills. Scary? Absolutely. But less so and in fact even misleading when you know three things.
Yes, we beg to differ strongly that scariness is BS (bad interpretation of science, and maybe just bad science). Here are three things you should know:
1. Estrogen used alone in this study decreased the risk of breast cancer in this and other studies, strongly suggesting the problem was with the combo.
2. Today's hormone therapy can be safer than that used in the study. So safe, in fact, that it's an intelligent option for the one in three women with nasty menopausal symptoms.
3. The safest HT also protects you from the number one killer of women: heart disease. If you're among the 83 million women in North America who are nearing or going through menopause, here's the science. Yes, we're going against the establishment, but you deserve the real data from the Women's Health Initiative (WHI) -- not the BS headlines from people who seem not to have cared about what the data in the study were -- and from other studies.
Hormones are better now. The latest headlines came from the WHI, which began in 1991. It monitored women taking high doses of Prempro, a mix of equine estrogens (from pregnant horses) plus a synthetic progesterone now known to antagonize estrogen's heart and breast benefits. While this combo is still prescribed (there's been a lower-dose form since 2003), you should insist on today's different -- and much safer IOHO -- types of estrogen and, especially, progesterone. They can lower your breast cancer risk and help your heart.
What are the newer, safer forms? Bioidentical estrogen (estradiol) and micronized progesterone, which doesn't block estrogen's artery-pampering effects. We and many other docs recommend them, and if you're already using HT, you may be taking them. They're sold by major companies as individual drugs (Estrace, Prometrium) and combo products (Angeliq).
Aspirin is essential. We have long maintained -- as does the U.S. government -- that most women over 55 should take daily aspirin to prevent clots. If you're on HT, underline that. Take 162 milligrams of aspirin daily (two low dose tablets or half a regular aspirin, with half a glass of warm water before and after). Start aspirin a few days before HT. Not only does aspirin reduce clotting, but aspirin itself may protect against breast cancer. There's evidence that taking aspirin seven times a week reduces breast cancer risk by 28 percent to 40 percent. Also, Harvard researchers report that women with breast cancer who have taken aspirin regularly are 50 percent less likely to die or have their cancer spread.
Start younger. Many experts think the increased heart attacks in the WHI study were because many women started hormones too late: at 63. By then, years of diminishing estrogen had already damaged their arteries. Among the study's youngest women, the heart attack risk was 8 percent lower. We think it is likely to be much lower than that with today's better hormones. What's also likely to be lower when HT is started earlier: memory lapses, fuzzy thinking and bone fractures. Current recommendations are to stay on HT for four years or less; that's when breast cancer rates began to rise in the WHI study. We strongly suspect that longer use will turn out to be more protective, but more data are needed.
Should you? If you're among the one in four women with relentless hot flashes, night sweats, insomnia or other extreme menopausal symptoms that occasionally make you want to tear your spouse's heart or hair out, talk to your doc. Good bet the new hormones (plus aspirin) will bring you relief and you'll net HT's other benefits.
The big question: If menopause isn't a big deal for you, should you take HT only for its heart, brain, bone and anticancer benefits? Here's where the arguments start. We and others think that for many women, the answer is yes because of HT's big potential benefits: preventing heart disease, which kills over 400,000 women a year and its ability to decrease breast cancer. Obviously, not everyone agrees. That's why we'd love to see a major new study that tests low, early doses of the best new hormones, taken with daily aspirin. However, getting the millions needed to fund such a study will probably not happen anytime soon. Fortunately, two important studies are already going on (ELITE and KEEPS) that are tracking the heart benefits of modern hormone regimens in younger menopausal women. We wish they had added aspirin; still, they're at a good start. Meanwhile, what's the best answer for you now? It's best to work with your doc to weigh your own risks and benefits.
Also seen on YOU Docs Daily You, by Dr. Mehmet Oz and Dr. Michael Roizen.