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[linz57]

Excellent post as always Hurdity, thank you.
These reports do make you worry a little but there are so many variables regarding dose, route, length of time etc etc and , until I see all the evidence I shall continue to use hrt.
In a few years there may well be yet another report saying it's safe, so many confusing studies.
I see my hrt as giving nature a helping hand, alongside healthy eating and exercise. If I were to come off my patch I would probably need anti anxiety meds , strong painkillers for my aching bones and pills for IBS. Those would put a strain on my liver and may well cause other problems down the line!

[coldethyl]

I think what matters is that a woman can make an informed decision about what risks she is prepared to take - it's always going to be a trade off between relief of current symptoms and long term risk/ benefit. Only the individual can decide whether symptoms are so unbearable that quality of life matters more than longevity. The problem of course is for doctors who have a duty of care to try and prevent harm to patients and have to take into account all risk factors when prescribing. Also , it's easy when caught up in the turmoil that is the menopausal transition to think that all that matters is the here and now and being symptom free- one may feel differently if one was unlucky and did develop hormone therapy related breast cancer down the line.
Although my aunt had breast cancer , my GP didn't rule out HRT use but explained the possibility of increased risk etc and i decided it wasn't for me at this stage.

[dahliagirl]

It is an increase in risk, not a cause.

They said that the risk returns to normal after 2 years of stopping, which makes it less likely to be a cause.

My in-laws both lived pretty teetotal lives with plenty outdoors, healthy food and followed health advice, had all the tests and check ups and had parents who lived to a grand old age.  They died at 71 and 73 of cancer.  My mother died of gallstones at 70 after years trying to keep her blood pressure/cholesterol down so as not to die 'early' at 78 like her father.

If I get past 70, then I am on to a winner.  Until then, quality of life.  I am not compromising for a tomorrow that may never come.

Fresh air, exercise, good food (and in my case HRT) help me to enjoy the life I have 

[Winterose]

 Two glasses of wine per day are apparently similar risk, breast cancer can be present 6 years before a tiny lump is noticed, so in many cases was most likely there and then exacerbated by the HRT or maybe not? Weight lifestyle and genetics will also play a part. Some people smoke heavily all their lives and dont get lung cancer.  Also the equine based HRT which was most commonly used in USA to me might be more disruptive to the body than the Bio Identical .  The numbers always look impressive until an expert comes along and puts them into persepctive

 

[Fedupofallthis]

I've read this study and it seems rather full of holes. The main one being that it talks of RELATIVE risk rather than absolute risk. If someone is better at statistics they may be able to calculate this for me as I am rubbish at stats.
I was also surprised that there was quite a few older women in the study.
The study also spoke of its limitations which should also have been taken more into account
They also seemed to have a high use of oral hormones rather than transdermal etc. The study was based on self-reporting by use of questionnaires so they could also have encountered bias there - if someone's drinking a couple of bottles of wine a night they are quite unlikely to state that on a questionnaire for example.

But I think the most important thing is that we have to remember that this is relative not absolute risk.

Here's a link to the study if anyone would like to see it

http://www.nature.com/bjc/journal/vaop/ncurrent/full/bjc2016231a.html

Personally I feel it is a case of the usual problem of journalists getting hold of a study and not having a clue what to do with what it really says.

Hope that helps!

[Emma]

This is on our news page
http://www.menopausematters.co.uk/newsitem.php?recordID=173/Effect-of-combined-HRT-on-breast-cancer-risk-likely-to-have-been-underestimated-new-study-finds

[zelda]

Interesting. Having read the info on MM News it will not in any way change how I feel about taking HRT. I will continue to use it for the foreseeable future.

It really does concern me though that there is so much conflicting evidence out there on these type of reports and it will of course make many women decide to stop taking HRT and without doubt increase the never ending bad press that HRT gets.

Like so many of you I know so many people who (even before this report came out) look at me in horror when I say I take HRT as if I am some kind of idiot but for me quality of life is more important.

[Mary G]

This study doesn't worry me in the least and it more or less confirms what most people know - it's the synthetic progesterone component of HRT that carries the breast cancer risk, NOT THE OESTROGEN.  I usually take these studies with a very large pinch of salt because they so often conflict and no doubt another study will come along soon which contradicts this one and they are always full of holes.

However, I do think there might be something in the theory that synthetic progesterone raises the risk slightly because it comes up time and time again.  Purely from my own personal point of view, I am dubious about any drug that causes breast pain.  My body decided to completely reject all forms of synthetic progesterone post menopause, perhaps it is an in-built  defence mechanism.   

It really is time to find an alternative to this outdated stuff not only because of possible breast cancer risk but also because of the endless, horrendous side effects - it really is nasty stuff.  The whole thing needs a radical overhaul with new guidelines (like the UK licencing Utrogestan to be used vaginally and actively encouraging women to use it in that way) and doses for the progesterone part of HRT need to be reviewed.  I think there are too many women taking too much progesterone in order to cover worst case scenario and this is not only damaging women's quality of life but also (slightly) raising breast cancer risk. 

For women who are just about to embark on HRT, I would suggest looking at a cyclical regime with Oestrogel and Utrogestan (micronised progesterone) because it carries fewer risks.  I think it is important to try and use progesterone vaginally because (a) it works better at lining clearance and (b) it has fewer side effects - like breast pain for example. 

For those who are happy with their continuous combined regime, I would say continue with it because the risk is very small.

Things need to change.

[Fedupofallthis]

Excellent post Mary. As a scientist this study doesn't worry me at all but the reports in the media do; yet again women are left confused and many will probably abandon the one thing that gives them relief and helps them cope. My answer is oestrogen patch + Mirena and maybe this is something that should be considered more. My GP calls it "the GPs perfect HRT regime". There's long cycle, there's Utrogestan and other things that can be considered but sadly the consensus seems to be to reach for the pills as a one-size-fits-all solution. Biological systems just don't work that way!

I'll keep fighting to keep my Evorel until I'm dead or reach 100. Whichever comes first.

[dazned]

This news wouldn't persuade me one way or other but sadly I'm afraid it will make gps even more resolute in not prescribing hrt,its just another reason they've been looking for as some of us here can vouch for 

[dahliagirl]

I had to come off the pill at 49 and was put on progesterone only (cerazette) which seems the way things are going.

As a result, I had breasts like melons, that were certainly as hard as melons, and sore, sore nipples.  So I tried a more usual POP after 6 weeks and they still did not go down, so threw in the towel after 12 weeks.  They are supposed to be better for breast cancer than COC but also, the small print says there is not as much research    I am sure there will be scares in the future about all the long lasting progesterone stuff they encourage these days.

I too think that it will make GPs who are not keen on prescribing HRT more resolute.

[Tinkerbell]

So, are there not risks in taking contraceptive tablets then, both have progesterone in them.
My friend has taken the POP for years but doesn't agree with HRT, even though she had premature menopause in her mid forties. Yet she happily indulges in a fair bit of wine and is overweight...both of which increases breast cancer risk.
I personally know three people who have had BC and the two who died were both under 40, so no HRT involvement there.
My worry is, as someone else said, that doctors will question prescribing it again.

[dahliagirl]

Or they will hide behind the lowest dose for the shortest time, ie 5 years only.

I'm not sure that these studies are helpful to the individual. It is an increase in risk to a population group. You do not have any idea of what the increase of 3 times is.  You do not know if it is an increase in 3 times of never getting breast cancer or 3 times the increase of a certainty, or one of the many places in between.  You either get a disease, or you don't (except for uncertain diagnosis) and not a percentage of one.

Also, you have to take into account the other things that you might be more likely to get or not likely to get and might die of.

It is exhausting    Sometimes you have to just hold your nose and jump.......or not.

[Fedupofallthis]

There is no answer, at least not as long as GPs are dumbed down by the government, have far too many patients and not enough time, and have NICE telling them what their every move must be and enforcing a "treat by cost and algorithm rather than treat people as individuals" culture. No wonder nobody wants to do general practice any more.

[coldethyl]

There is no answer, at least not as long as GPs are dumbed down by the government, have far too many patients and not enough time, and have NICE telling them what their every move must be and enforcing a "treat by cost and algorithm rather than treat people as individuals" culture. No wonder nobody wants to do general practice any more.

for me, that is the crux of the debate, not the relative risk factor of any given treatment. It may well be that HRT really isn't that safe ( I'm not a scientist, I haven't read enough etc so I don't know) but what it does do is ameliorate the rubbish symptoms that an overstretched GP surgery either ignores or pushes you onto various psychiatric drug cocktails. If further research shows that the risk of extended use of HRT is dangerous with the risks outweighing the benefits to all but a small number of women ( I'm thinking those facing a very early menopause) then something else is going to have to be put in place to support the large numbers of women who don't find the transition a breeze, emotionally or physically. Personally I've had so many trips to the doctors since this started and not once have any of the HCPs I've seen offered anything other than anti-:depressants or the possibility that HRT might be the way forward at some far off point that we never seem to get to. I'm not suggesting that a listening ear and support would be as good as HRT for all, but it would be a start and surely it's better to have those sort of health care systems in place for the eventualities that new medical research might throw up about any manner of drug treatments.