Hormone replacement therapy (HRT), also known as menopausal hormone therapy (MHT) has been on quite a roller coaster in the public eye. At one point in the U.S., it was one of the most commonly prescribed prescriptions—but that has since changed.
Part of the reason for the fear and confusion around the safety of HRT is due to 2002 findings from the long-running Women’s Health Initiative study (which was almost defunded recently by the federal government), suggesting that HRT could significantly increase breast cancer, stroke and cardiovascular risk.
This has since been debunked, but the HRT stigma remains.
In a conversation at the first annual Flow Space Women’s Health Summit LA moderated by Flow Space editor-in-chief Galina Espinoza, Dr. Suzanne Gilberg-Lenz, founder and author of Menopause Bootcamp and chief clinical officer of Monarch MD, discussed the implications of this research.
“They suddenly released the data, saying… the patients who are on the hormone replacement therapy, (they were comparing hormone replacement use to non use) have a 25% higher risk of breast cancer,” Gilberg-Lenz explained. “Everybody freaked out, and people were throwing out their hormones.”
The data was “massaged” and may have been misinterpreted by the public, according to Gilberg-Lenz.
“The reality was that the increased risk was less than one person per 10,000 using the kind of hormone therapy that was used at the time,” she said. She also pointed out that these women studied were past menopausal age, in their 60s and 70s, and were therefore already at an increased risk for heart attacks, strokes and breast cancer.
Still, the damage from the study was done, in a way.
For instance, in the mid-1990’s when the Women’s Health Initiative (WHI) study began, close to 40% of women in the U.S. took hormone therapy for menopause symptoms, compared to today, when only around 4% of women take it, Gilberg-Lenz pointed out.
Understandably, there is heightened fear around breast cancer risk with HRT for people who have a family history. That’s when it’s really important to look at the evidence, said Dombo, Alloy Women’s Health director of advocacy, outreach and prescribing.
“It takes conversations, listening and showing them the evidence and guidelines so that you understand, OK, this is the risk-benefit ratio, and your risk as someone with a family history of breast cancer is not going to preclude you from taking hormones,” Dombo explained.
Lang, an author, educator and board-certified OB-GYN specializing in holistic gynecology & preventive oncology, added to the conversation that breast cancer risk can be increased by alcohol use. She argued that it’s much more of a concern for cancer over estrogen therapy side effects.
Though predisposition to breast cancer is not within your control, it’s also not simply a game of chance. There are a few preventative measures you can take to mitigate your risk, according to Lang. “A whole foods, plant-based diet, you cannot go wrong: You are going to drop your cardiovascular risk, your dementia risk… breast cancer risk,” she said.
Vigorous exercise is another key to keeping your metabolism going, which can support your brain health, as well as sleep optimization. “These are the things where the data is just… there’s no debate that these things help with menopause,” said Lang.