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MHT & That Breast Cancer Study

The one thing that comes up when you start talking menopause is hormone replacement therapy (aka HRT) and that breast cancer study which convinced the world that there was a massive risk of breast cancer attached to HRT. In this post I want to present all the facts, all the science, and the actual results from the study along with the interpretation by the British Menopause Society (BMS), International Menopause Society (IMS), European Menopause and Andropause Society (EMAS), Royal College of Obstetricians and Gynaecologists (RCOG) and Australasian Menopause Society (AMS). Of course, everyone must make their own decision when it comes to their health and treatments. I am not a medical professional, so I strongly encourage you to speak with your medical professional or GP before making any decisions, as your personal health history is a very important factor when considering any treatment for perimenopause and menopause symptoms. I also think it is equally important that we are all fully aware of the facts and not scared off by historical and incorrect interpretations of medical studies. So, let's take a closer look so we can be better informed, educated, and prepared when we do have the conversation with our GP.


Menopausal Hormone Therapy (MHT), previously known as Hormone Replacement Therapy (HRT), is recommended for treatment of symptoms of the menopause. MHT is just the new name for HRT and there is no difference between the two - it's just terminology. The most common reason women start MHT is for the relief of vasomotor symptoms such as hot flushes and night sweats. MHT can reduce these symptoms by around 80%. Menopausal symptoms usually last for five years, although they can last as long as 10 years. About 20% of women will experience severe symptoms and 20% experience minimal or none.


In women who no longer have a uterus, estrogen-only therapy is adequate, unless extensive endometriosis or sub-total hysterectomy. MHT is available as tablets, patches, gels, or vaginal treatments. The type of MHT needed and the associated risks varies according to your age,

whether you have had a hysterectomy, whether you have other health conditions. Your doctor can tailor the type of hormone treatment best suited to you.


Current research shows that MHT is both a safe and effective way to treat symptoms of menopause in women if commenced within 10 years of natural menopause. MHT should not be commenced after the age of 60. Women who go through menopause before 45 years are advised to take MHT until the average age of the menopause (51 years). The risks of MHT are not significant until after this time. Women taking MHT should be reviewed annually by their GP.

Different menopausal hormone therapy tablets and pills

The British Menopause Society (BMS), International Menopause Society (IMS), European Menopause and Andropause Society (EMAS), Royal College of Obstetricians and Gynaecologists (RCOG) and Australasian Menopause Society (AMS) wish to clarify the evidence on the risk of breast cancer with menopausal hormone therapy (MHT) in response to the recommendations of the European Medicines Agency (EMA) - the central European drug regulatory body - Pharmacovigilance Risk Assessment Committee on 11-14 May 2020 that followed on from a meta-analysis by the Collaborative Group on Hormonal Factors in Breast Cancer (CGHFBC) published in the Lancet on 30 August 2019.


Results from the CGHFBC meta-analysis show a small increase in the absolute risk of breast cancer:

  • 5-years intake of MHT starting at the age of 50 years and risk of breast cancer at age 50-69 years

For continuous combined MHT Increase from a baseline risk of 3/50 women not on MHT to 4/50 (i.e., 1 extra case in 50 women).

For sequential combined MHT Increase from a baseline risk of 4/70 women to 5/70 (i.e., 1 extra case in 70 women).

For oestrogen only MHT Increase from a baseline risk of 13/200 women to 14/200 (i.e., 1 extra case in 200 women).

  • 10-year intake of MHT starting at the age of 50 years and risk of breast cancer risk at age 50-69 years

For continuous combined MHT Increase from a baseline risk of 3/50 women not on MHT to 5/50 (i.e., 2 extra cases in 50 women).

For sequential combined MHT Increase from a baseline risk of 4/70 women to 6/70 (i.e., 2 extra cases in 70 women).

For oestrogen-only MHT Increase from a baseline risk of 13/200 women to 15/200 (i.e., 2 extra cases in 200 women).


What this means for women who have no family history of breast cancer, is that MHT can increase a possible risk of breast cancer by 0.5% to 2% (5-year intake) or 1% to 4% (10-year intake). The average woman (non-smoker, non-drinker, healthy weight) has a risk of developing breast cancer in her lifetime of one in seven or 14%, with the majority of breast cancer cases (about 80%) occurring in women over 50 years of age. (National Breast Cancer Foundation Australia). This means that if you were looking into MHT for up to ten years, you would increase your risk of breast cancer from 14% to 15% if taking continuous combined MHT (oestrogen + progesterone). As you can see, this is not a massive increase in the risk, however it is still something to consider and discuss with your medical professional or GP to ensure that this treatment is suitable for you.


MHT helps to relieve symptoms of perimenopause and menopause by replacing oestrogen that naturally declines with age. MHT also offers protection against bone loss and fractures, cardiovascular disease, type 2 diabetes, clinical depression, colon cancer and dementia. It usually takes several weeks before you feel the initial benefits of MHT. The full effect may take up to three months. It may also take your body time to adjust to MHT. When you first take MHT, you may experience side effects such as breast tenderness and swelling, irregular bleeding, fluid retention, bloating and nausea. These symptoms often subside with time. However, if these side effects persist you may need to see your doctor for a different type of MHT or dosage adjustment.


Unfortunately for me, I couldn't use MHT due to a pre-existing health condition that results in blood clotting. There are other health conditions that also make MHT a big no, so please always talk to your doctor. However, if you are suitable for MHT and you and your medical professional agree that it is a good treatment to go with, then do it. The women who I know who have been on it or are still on it can't praise it enough. From having more energy, less night sweats and hot flushes, to not gaining the meno-belly, they are feeling really good about menopause with MHT. And this is what I want for women - to go through peri and menopause feeling as positive and good as they possibly can be. Yes, here will be symptoms that aren't much fun, but with treatments and strategies we can get through it and rejoice! For me personally, I was overjoyed when my period stopped. No more tampons, pads, ruined underwear, and PMT. I'm looking to purchase a pair of designer white trousers and wearing them with such confidence! This is the joy of being post-menopausal.



Resources

Type and timing of menopausal hormone therapy and breast cancer risk: individual participant meta-analysis of the worldwide epidemiological evidence, The Lancet (2019)


Australasian Menopause Society - What is Menopausal Hormone Therapy MHT and Is It Safe?


Jean Hailes for Women’s Health website: https://www.jeanhailes.org.au


Life Begins at Menopause? A guide to the changes at midlife and menopause for women and their partners by Dr Mandy Deeks


Queen Menopause by Alison Daddo


Podcasts

  • 456 Club

  • Ladies We Need to Talk

  • The Hot Flush

  • Peri Menopause Power


DISCLAIMER: THIS WEBSITE DOES NOT PROVIDE MEDICAL ADVICE

The information, including but not limited to, text, graphics, images, and other material contained on this website are for informational purposes only. No material on this site is intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your doctor, general practitioner (GP), or other qualified health care professional with any questions you may have regarding a medical condition or treatment before undertaking a new health care regimen, and never disregard professional medical advice or delay in seeking it because of something you have read on this website.

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