Dr Frances Pitsilis - Questions to ask when considering hormone therapy

When considering hormone therapy, many aspects of its risks and benefits must be taken into account as well as the individual’s personal health profile.

Firstly, why would you consider taking hormones?

It would only be if you had significant symptoms that needed help. These would include hot flushes, disturbed sleep, crawling feelings on the skin (doctors call them formications), serious anxiety, and many other physical symptoms.

Some younger women may be placed on hormone therapy to protect their health because of early menopause or early hysterectomy.

What other options do I have?

Depending on how a person feels and functions there is not necessarily the need to take hormones. A person may have no therapy at all. Alternatives that may help with some symptoms include:

• Trialling drug, herbal and other therapies.
• Keeping the hormone therapy down to a minimum.
• Having only bioidentical hormones.
• Or having synthetic hormones prescribed by other doctors.

However, bioidentical hormones (made by a compounding pharmacy) are not necessarily safer that those made by drug companies. More on that later.

What are the international guidelines on hormone therapy?

The latest scientific papers discussing hormone therapy have suggested the following:

1. Do not take it unless you have a need.
2. Consider the persons risks of Breast cancer.
3. It should be estrogen through the skin +/ - micronized progesterone.
4. If a woman uses the right hormone therapy for 5 years within the 10 year window from menopause, she can be protected from Heart disease, stroke and alzheimers disease.
5. It appears the estrogen patches and similar skin estrogen therapies are the safest because estrogens taken by mouth increase blood clotting as well as heart attack and stroke.
6. The safest Progesterone is micronized progesterone as it doesn’t have any adverse effects on the heart as synthetic progestin type medications have. It doesn’t increase breast cancer risk like synthetic progestins do.
   
   

What factors may influence the risk of breast cancer?

1. Ages – it is a simple as this. Breast cancer risk increases with age.
2. Any personal or close family history of breast cancer. However, up to 85% of women diagnosed with breast cancer have no close relatives with it.
3. If a person carries the BRCA1 or 2 gene.
4. Having had radiotherapy to the chest for any reason eg Lymphoma.
5. Certain conditions that may be associated with increased risk eg Overweight, Diabetes type 2, Polycystic Ovarian syndrome, autoimmune diseases, on any immune suppressing drugs.
6. Starting your period at an early age increases risk. If age 14 or later the risk is reduced.
7. Having your first child late or never having children increases the risk.
8. Having a close relative with Ovarian cancer may increase the risk.
9. Having had abnormal breast biopsies may increase the risk.
10. Some races have a higher risk.
    
    

What about bioidentical hormones?

Bioidentical hormones are not necessarily any safer than hormones made by drug companies. Here are some important points to consider:

1. The hormones recommended internationally are made by drug companies and are actually bioidentical – the same as in the body.
2. “Bioidentical hormones’ is a label given to hormones that are again, the same as in the body, but made by a compounding pharmacy.
3. What is important is that estrogen must be through the skin and that micronized progesterone is used. NOT oral estrogen or synthetic progestins.
4. Estrogens taken by mouth increase blood clotting, heart attack and stroke. If you are on these, ask to convert to the ones via the skin.
   
   

What health screening should women have to detect breast cancer early?

1. Have a yearly breast check up with your family doctor.
2. Get used to your own breasts and promptly report any changes.
3. Have breast imaging regularly as recommended by your doctors. This will be in the form of mammograms and ultrasounds. Two types of imaging are better than one ie mammogram plus ultrasound. This is especially if your risk is higher or you have dense breasts. In some special cases, MRI imaging is useful eg younger patients at higher risk.

What lifestyle changes can be made to reduce risk?

1. Be in bed and asleep by 10.30pm so your body makes Melatonin which protects the breasts.
2. Eat a rainbow of vegetables. Especially eat brassica vegies – organic kale, broccoli, cauliflower, cabbage, brussel sprouts. In particular, broccoli sprouts are more protective because they contain more Sulphorophanes.
3. Keep your self lean and do not allow significant weight gain, especially around the waist.
4. Do regular exercise – 45 minutes of aerobic exercise 5 days per week.
5. Manage stress and live your life with a good attitude. “Don’t sweat the small stuff”. Keep things in perspective. Decide what is important. Focus on friendship, emotional support and adequate rest and recreation. Don’t work too hard.
6. Consider taking omega 3 fish oil, use extra virgin olive oil, and green tea.

References:

1. D. Duvall, D. Plourd. Update: Management of menopausal and postmenopausal Symptoms http://npwomenshealthcare.com/wp-content/uploads/2014/01/CE-Meno_F14.pdf
2. Richa Sood et al. Prescribing menopausal hormone therapy: an evidence-based approach. International Journal of Women’s Health 2014:6 47–57
3. T.J de Villiers et al. Updated 2013 International Menopause Society recommendations on menopausal hormone therapy and preventive strategies for midlife health. CLIMACTERIC 2013;16:316–337
4. Nick Panay et al. The 2013 British Menopause Society & Women’s Health Concern recommendations on hormone replacement therapy. http://min.sagepub.com/content/early/2013/05/23/1754045313489645.1