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HRT

Cler
Posts: 26
Joined: Jan 2011

Hello,

just wondering if anyone else has been given Hormone Replacement Therapy. Due to my age (34)following the hysterectomy I was given estrogen only HRT. I am ER- and PR- so my doctors think this is ok for me but I am nervous.

They have told me that my menopause symptoms will be very extreme and taking the HRT will improve my quality of life. My doctor told me quality of life is more important than quantity of life which makes me think that the HRT may possibly drive the cancer eventually.

It's very confusing as to what to do for the best.

Has anyone had experience of HRT?

Thanks,
Cler

daisy366's picture
daisy366
Posts: 1493
Joined: Mar 2009

Hi cler,

When I read what your doc said, I thought "easy for you to say!". I think we each need to make this decision for ourselves. Your doc's job is to give you information and give his advice and let you make decision. Sounds like you need more info - from doc or internet and the people here who have had your situation.

I was already past menopause when I had hysterectomy. I did however reject HRT during menopause. But you are very young. I'm not one to make suggestion to you on this topic.

I wish you all the best. Mary Ann

Songflower's picture
Songflower
Posts: 632
Joined: Apr 2009

I would get a second opinion if I were you. What type of cancer do you have? What grade or metastasis. At your young age I imagine a good prognosis but I am not certain about this advice. I still hang with a second opinion.

Diane

Songflower's picture
Songflower
Posts: 632
Joined: Apr 2009

I would get a second opinion if I were you. What type of cancer do you have? What grade or metastasis. At your young age I imagine a good prognosis but I am not certain about this advice. I still hang with a second opinion.

Diane

jazzy1's picture
jazzy1
Posts: 1387
Joined: Mar 2010

My doc told me no HRT!!! Way too many hormones and that's not good for my type cancer...I'm a grade 3C, so have to be very careful.

I was perio-menopause before hysterectomy and after surgery I was waiting for the side-affects from menopause. Even asked my doc about them as didn't have the "hot flashes". Told me consider yourself lucky and wanted me to be watchful of depression. Can only assume I skated thru that stuff...knock on wood!

You know there's a lot of "natural" type supplements which help with menopause. If interested I can send you what my friends were using, as I just used my personal setup of vits which aren't really directed to menopause.

Definitely agree with Diane...consider a second opinion!! Better to be safe vs. sorry....

Best to you,
Jan

HellieC
Posts: 439
Joined: Nov 2010

I had a hysterectomy for atypical hyperplasia when I was 43. No cancer was found. I was recommended HRT (combination) as it was felt that I was young and an enforced menopause could lead to early osteoporosis and other issues. Sounded sensible to me, so I went on it with the aim of staying on it until I was nearer "normal" menopause age and then coming off it gradually.

However, I was diagnosed with a "recurrence" of endometrial cancer 7 years later, even though no cancer was found in the original hysterectomy pathology (it was checked and rechecked following my recurrence). So there must have been one or two pesky little cancer cells first time round which hid themselves away! In my mind, I believe that taking HRT contributed to the recurrence. Of course, no one can ever be sure, but that's the way I feel. If I could go back and choose again, I would accept the risks associated with an early menopause rather than take HRT again.

It's a personal choice and I am sure there are lots of women out there who have taken HRT safely and effectively for their menopausal symptoms. However, the clinical "jury" still appears to be "out" regarding this one, so get as much advice and opinion as you can before you make your decision.
Wishing you good health
Helen

Cler
Posts: 26
Joined: Jan 2011

Hello friends,

Wow! Thanks for all this info. I really need to ask a lot more questions and do a lot more research. I started getting some night sweats during chemo and hot flashes and they immediately put me on HRT. I didn't even investigate other natural options. Well, to be honest, I had a lot on my plate at the time to worry about so I kind of just went with it!

I really feel instinctively that you are right Helen. It's a weird sense I have in my heart that taking these pills is not a good idea.

I'm going to make some further appointments and do some research and really check that this is the right thing. I really feel even the doctors don't know if it's risky or not, so maybe it'll come down to a personal choice in the end.

Thanks so much to you all for taking this time to share your experiences. It's really invaluable to me.

Thanks!!
Cler

upsofloating's picture
upsofloating
Posts: 473
Joined: Dec 2009

I saw this study yesterday relative to HRT to prevent early menopausal issues. However I find it quite counter-intuitive since the usual reason for removing ovaries in BRCA-positive women is to diminish production of hormones. But I'm not the expert. Just presenting it as info that is out there....

HRT Post Oophorectomy Adds No Breast Cancer Risk
Elsevier Global Medical News. 2011 Jun 28, S London

CHICAGO (EGMN) - Women who have a BRCA mutation and undergo prophylactic oophorectomy can use hormone replacement therapy to control menopausal symptoms - at least in the short term - without experiencing any increase in the risk of breast cancer, new data suggest.

In an observational cohort study of more than 1,200 BRCA carriers, roughly half of those who underwent risk-reducing salpingo-oophorectomy also used hormone replacement therapy (HRT). The average duration of follow-up was about 3-5 years.

Study results, reported at the annual meeting of the American Society of Clinical Oncology, showed that oophorectomy reduced breast cancer risk as intended, and that HRT users after oophorectomy did not have an elevated risk of breast cancer, compared with nonusers.

"While further data are needed, short-term HRT can at least be considered for mutation carriers undergoing early oophorectomy for ovarian and breast cancer risk reduction," said Dr. Susan M. Domchek, who presented the findings on behalf of the PROSE (Prevention and Observation of Surgical End Points) Consortium.

"I hear a lot from my patients these days that their relatives do not want to come in for genetic testing because they have been told that they are required to have a bilateral mastectomy and oophorectomy, and are not permitted to take HRT," she commented. "If this is dissuading women from coming in, we have to have a real conversation that, although data are limited, this may be an option for patients."

The PROSE database was developed by 20 centers in the United States and Europe who identified and prospectively followed women with a deleterious BRCA1 or BRCA2 mutation. For the study, the investigators focused on those who at ascertainment had at least one ovary, no prior breast or ovarian cancer, no prior bilateral mastectomy, and at least 6 months of follow-up.

Results were based on 1,299 women; 61% had a BRCA1 mutation and 39% had a BRCA2 mutation. (Those with both mutations were excluded.) Overall, 25% underwent risk-reducing salpingo-oophorectomy, and of this group, 45% used HRT afterward.

The mean duration of follow-up was 5.1 years among women who did not have oophorectomy and never used HRT, 3.6 years among women who had oophorectomy and never used HRT, and 5.4 years among women who had oophorectomy and used HRT.

Breast cancer was diagnosed in 22% of the women overall, but in only 13% of the subgroup who underwent oophorectomy.

Study results showed that women who used HRT after oophorectomy did not have an increased risk of breast cancer (and in fact tended to have a decreased risk) whether they were compared with women who did not use HRT after oophorectomy (hazard ratio, 0.78) or with women who did not have oophorectomy and never used HRT (HR, 0.43).

The findings were similar when BCRA1 carriers and BRCA2 carriers were analyzed individually, noted Dr. Domchek of the Abramson Cancer Center at the University of Pennsylvania in Philadelphia.

Additionally, there was no increased breast cancer risk according to the type of HRT taken after surgery, whether combined estrogen-progestin (taken by women who had only their ovaries and fallopian tubes removed) or estrogen only (taken by women who had had a hysterectomy as well).

Finally, in analyses restricted to women who did not undergo oophorectomy, those who used HRT any time after natural menopause did not have an increased risk of breast cancer, compared with their counterparts who never used HRT, and again tended to have a reduced risk (HR, 0.52).

"It's worth pointing out that the mean age at the start of follow-up is significantly different between these two groups," Dr. Domchek cautioned, at 49 years in the former and 34 years in the latter. "And this really may be a different group that becomes menopausal without any cancer diagnosis."

Dr. Domchek acknowledged that the study was not randomized, that the numbers were small in some subgroups, and that follow-up was limited. But "the perfect can be the enemy of the good at times," she cautioned.

"These women have estrogen floating around their bodies now and want their ovaries out, so they don't die of ovarian cancer. So even if [HRT] maintains their risk at where it is before their ovaries are out, at least they don't get ovarian cancer," she said. "I really feel that if we wait [until the data are] perfect, and women won't have an oophorectomy because they are terrified about menopause, [then] that hasn't done them any good, either."

Additionally, many women may be fine with short-term use of HRT, which gets around the issue of elevated breast cancer risk seen with longer-term use of combination HRT in the Women's Health Initiative. "If longer-term use [is desired], then you can have a discussion with women about hysterectomy so that they can take estrogen only," which was not found to increase risk. "I think these are subtleties of the counseling process as well."

Moreover, participants in the Women's Health Initiative had a median age of 63 years, which was much older than the mean age of 38 years for the BRCA carriers studied. The former "are women who had gone through their whole natural life with estrogen and then [had taken] more, so potentially, it's not relevant to this population of patients."

Discussant Dr. Lynn Hartmann, an oncologist at the Mayo Clinic in Rochester, Minn., cautioned about the pitfall of unknown biases in observational studies. "I can tell you from participating in cohort studies myself that there are biases that one cannot even imagine that can seep into your study sets," she said.

In the PROSE study, the types of cancers resulting from a BRCA mutation in a family might have influenced which women underwent oophorectomy. And a woman's breast history (for example, atypia) might have influenced whether her physician offered HRT after oophorectomy.

Dr. Hartmann commended the investigators for developing a large, multi-institutional registry; conducting a high-quality study; and addressing an important, relevant clinical question.

"But I think we do have to have some skepticism when treatment questions are tried to be answered from these types of [study] designs," she said. "I would at least ask the PROSE team ... to consider whether or not they could move into prospective clinical trials with their cohorts."

Dr. Domchek and Dr. Hartmann reported that they had no relevant conflicts of interest.

Copyright © 2010 International Medical News Group

HellieC
Posts: 439
Joined: Nov 2010

I think it's good to bring forward these sorts of studies and debates, so we have as much information as we can. But I agree that it does feel counter-intuitive to give hormones, having just taken away the hormone-creating organ!

I remember reading several abstracts a few years ago, when I was looking at the whole HRT "thing" after my first recurrence. There really was no clear concensus at the time, although some ob-gyns in the UK were very against HRT whereas others said there was "no evidence" not to give it.

Of course, in my case, there was no evidence of cancer in the pathology following my hysterectomy, and so the advice to take HRT seemed sensible from all sides! I was on HRT for 7 years, which is longer than the follow up for this study. Perhaps future studies will identify an optimum timeframe for taking HRT (just like there is for tamoxifen post breast cancer)?

We have such a long way to go to get all the answers we need. But it's great to be able to share our knowledge on a forum like this. I don't know how I managed before I "met" all you lovely ladies!
Kindest thoughts
Helen

daisy366's picture
daisy366
Posts: 1493
Joined: Mar 2009

Western medicine is ruled by pharmacy, I think. Doctors are trained to treat symptoms - pills for everything. Glad we are having this discussion. There are very effective natural treatments - however, natural doesn't always mean healthy. Make sure you do enough research.

Best wishes. Mary Ann

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