The Truth about Hormone Therapy

There is a lot of misinformation out there and women are searching for reliable sources of information.  I’ve made this quick quiz to check out YOUR knowledge about Hormone Therapy (HT).

True or False;

1.       Estrogen therapy causes Breast Cancer.
2.       Combined HT (Premarin with Provera ) causes breast cancer.
3.       The leading cause of death for women in the United States is breast cancer.
4.       Hormone therapy increases the risk of cardiovascular disease.
5.       Hormone therapy reduces the risk for osteoporosis and hip fracture.
6.       If a woman is using Vaginal Estrogen Therapy she needs to also take progesterone to protect the uterus.                                                     

•       Estrogen therapy causes breast cancer.  FALSE

The Women’s Health Initiative (WHI), the most widely recognized randomized controlled study Involving hormone therapy, had 2 different arms.  One which included Premarin (estrogen derived from Pregnant Mare’s urine) with synthetic progestin ( Provera) and another arm with estrogen alone. – both of these arms were compared to placebo arms ( women taking no hormones- also known as placebo pill(s)

After 5 years in the estrogen only arm of the WHI study, women taking Premarin had less cases of  breast cancer compared to the placebo group. Those women who took estrogen were less likely to develop breast cancer than those who were not taking it.   Thus, estrogen therapy does not CAUSE breast cancer.

•       Combined HT using Premarin and Provera causes breast cancer.  TRUE

In this arm of the study, there was an increased relative risk of 1.26, meaning an increased risk of 26%.  Looking at the incidence of breast cancer at the average age of the women in the study, 63, the average risk of breast cancer is 30/10,000 women.  By adding a relative risk of 26% this would increase the number of cases to 38/10,00 – a difference of 8/10,000 women / year.

•       The leading cause of death for US women is breast cancer.  FALSE

The leading cause of death in the U. S for women is heart disease, which includes stroke and heart attack.  One out of every 5 women will die from heart disease during her lifetime. Cancer is the second leading cause of death with lung cancer being the leading cause of cancer death in women.

•       Hormone therapy increases the risk of heart disease.  FALSE

If a women starts HT within 10 years from the onset of menopause, she will have a reduced risk of heart disease.  This is known as the “window of opportunity” for protection against cardiovascular disease.  Women who already have a history of heart disease should not start HT because they may increase their risk if they start taking HT.

•       Hormone therapy reduces the risk for osteoporotic fracture.  TRUE

In both arms of the WHI, it was shown that estrogen alone or estrogen combined with synthetic progestin reduced the risk of hip fracture. 

•  If a woman is using vaginal estrogen therapy she needs to also take progesterone to protect the uterus.  FALSE                                                                                   

All of the vaginal estrogen therapy, except Femring, are localized estrogen therapies which do NOT affect systemic blood levels.  

Femring is a vaginal ring which is used to treat systemic symptoms such as hot flashes, night sweats, etc. and delivers a much higher dose of estrogen into the bloodstream.  With this form of therapy, progesterone will be needed to protect a woman’s endometrial lining, unless she has undergone removal of the uterus, known as hysterectomy.

If you are on localized vaginal estrogen therapy, you do NOT need to take Progesterone.

Are you surprised by some of the answers?  You’ll be happy to know that the majority of women do NOT know the answers to these questions. That’s why in the Amazing over 40 community and website we provide you with up-to-date and accurate information to help you make the best choices for your health – wherever you are in the world!

–          In health and happiness

Dr. Diana Hoppe

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