I am happy to report that little by little we are starting to accumulate some scientific data on hormone replacement safety.
Bioidentical hormones have been in use for over 30 years. Yet there is a paucity of scientific information on their safety due to a lack of financial resources to perform proper medical studies. Most pharmaceutical studies are performed by drug companies deeply financially vested in bringing a drug to market that will generate significant profit. There is generally tremendous financial incentive to a company attempting to prove the efficacy of a new drug.
In terms of bio identical hormones ,however, there is no one company that stands to prosper from performing such a study. Bio identical hormones are compounded by "mom and pop" pharmacies, who do not have the resources for obtaining a patent and therefore exclusive rights and profits from that substance.
Luckily there are organizations and educational institutions that are interested enough in the effects of hormone replacement that studies are being performed. Two studies are currently underway in europe. One is in Finland and one in France. Both sudies are evaluating the safety of estrogen replacement in women after menopause using bio identical hormones. To date (after about 7 years each) both studies are not reporting any increase incidence in breast cancer in women who start taking their hormones close to or before the onset of menopause.
Additional studies in 2005 and 2007 from over 50,000 women showed no increase in breast cancer and a small 10% reduction in breast cancer in those women using bio identical hormones with natural progesterone, and a 40% increase in breast cancer in women using the artificial progestin(provera).
This is somewhat startling information and in sharp contrast to the data coming out of the Women's Health Initiative study which to date has been the landmark study most often cited as being the 'holy grail' of menopausal hormone replacement. However, even looking more closely at that terribly flawed study, one might note that there is an arm of the study where women took only equine estrogen without the synthetic progestin, and those women also showed no increase in breast cancer, heart disease or stroke as was previously reported.
The cardiovascular protective effects of estrogen are well known. However these benefits are reversed when progestin is part of the protocol.
Even in breast cancer survivors, those women taking natural estrogen and progesterone have lower overall mortality.
It begins to appear more evident that the real culprit is the synthetic oral progestin, not the estrogen after all.
There is little controversy about testosterone replacement for post menopausal women reducing risk and incidence of breast cancer and reducing recurrence rates amoung breast cancer survivors. Added into the mix these three hormones can significantly improve women's quality of life after menopause.
There are many other risk factors to consider when discussing hormone replacement. Proper nutrition, avoiding too much omega 6 fats from animal protein,avoiding acidifying the blood, stress, lack of exercise,lack of sleep,exposure to toxins ,having too high body fat and BMI all contribute to altered estrogen metabolism and increase the risk of breast cancer through altering metabolism or adversely expressing genetic information.
I can't emphasize enough the importance of diet,exercise and maintaining ideal body weight in reducing cancer risk,as well as heart disease.
If you are interested in maximizing your health please call the office and schedule a consult with Dr. Liebowitz to discuss your options for hormone replacement therapy.