Bioidentical hormones - no safer

Anonymous

"We observed lower risks of recurrence and mortality in women who used HRT after breast cancer diagnosis than women who did not."

http://jnci.oxfordjournals.org/content/93/10/754.full.pdf

This is quite a paradox. We're finding evidence that both suppressing hormones and taking hormones reduces recurrence. I wonder why?

I think we can rule out the fueling theory --or the patients taking HRT would have recurred an died more than the non takers.

Anonymous

Kayb, actually, there are about 20 more studies that have similar findings to the one I posted above.

Have you checked Pubmed? Do you have any theory about how both blocking hormones and taking hormones could be beneficial? While the people doing nothing about hormones have trouble? This is driving me crazy. I hope we have an answer in our life time !

AnnAlive

I'm facing this dilemma now. After completing all my bc treatment, I'm suffering adrenal fatigue and not feeling well at all. I'm seeing an HRT specialist who is prescribing bioidenticals to balance my hormones, to rebuild my adrenal levels. I have been taking bioidentical oral progesterone and bioidentical DHEA-S cream for almost three months (and I don't see improvement in my energy or insomnia yet). 

Then I just had my 6-month appointment with my MO two weeks ago. My PET scan and labs were fine, but she had a polite FIT that I am taking ANY hormones, saying bioidenticals are not safer than other hormones, and that I could stimulate any latent breast cancer cells to have a recurrence/metastasis. Note below that my cancer was ER-/PR-, which my MO (and other sources) says still presents a risk, because the receptors are known to change + or - sometimes in a recurrence. 

I did question my hormone/endocrine specialist at my first visit about whether hormones could cause a recurrence, and she assured me that bioidenticals are safe (quoted the French cohort study and gave me a copy of her own journal article on the subject). Well, I emailed her after my MO visit, stating my concerns (and MO's advice to stop hormones) and I am weaning off now, headed for a visit with this doctor the end of this week. I am nervous about it, not knowing if she will again try to convince me the bioidenticals are safe, or have a plan B to help my adrenals, or else dismiss me as a patient if I decline her prescribed therapy. I've been reading up and don't see enough evidence that bioidentical hormones are safe after breast cancer.

We don't seem to have the data! Any help?

Fallleaves

This is about a study showing estrogen-only HRT actually reduced BC risk and mortality from BC: 

http://www.medicalnewstoday.com/articles/242620.php

It seems like the progestins are the real offender in HRT.

Fallleaves

But this study looked at estrogen/progestin and estrogen only HRT's, and BOTH led to higher risk after long-term use (over 10 years)

http://www.sciencedaily.com/releases/2012/04/120401134933.htm

Hmm, not a very clear picture on the hormone front.

SelenaWolf

Which is why I'm drawing my line in the sand and not touching them until more decisive information is available.  There is just too big a "grey area" to risk it, in my opinion.  But I will still be keeping an eye on the research to see where it goes...

Fallleaves

Yeah, I am l leery of taking hormones, natural or not. I think you really need to have a compelling reason to take them, and really understand the differences between the various forms of each hormone and their specific effects. 

Fallleaves

AnnAlive, I found this on pubmed, but it was just an abstract, not a full article on bioidenticals. It would be interesting to read more. Haven't run across anything that specifically addresses the use of bioidenticals in women who already have breast cancer, though. I hope your HRT specialist will be able to give you some alternatives. It's definitely a balancing act trying to deal with a variety of health issues.

http://www.ncbi.nlm.nih.gov/pubmed/19179815

BrooksideVT

Lucy, I read most of the study you posted, and do find it food for thought.  I have two main concerns: The relatively tiny size of the study and its 2001 publication date.  In twelve years, I'd expect some definitive follow up research, and there just does not seem to be any.  Nobody on these forums has posted anything pertinent, or have they? 

Like Selena, I'm going to give these things a wide berth for now.  I think they may be OK for those not diagnosed with BC, but those ladies are quite another segment of the population from us post diagnosis folks.  I know my tumor loved estrogen and progesterone (90% positive for both) and can't imagine any leftover cells turning their little noses up at a hormone buffet.

Momine

Brookside, Selena posted an article from Harvard that gives a pretty good overview of the research.

It says, among other things: 

"Many women and health experts continue to struggle with the turnaround in attitude toward hormone therapy in the wake of the Women’s Health Initiative (WHI) trial of combined estrogen and progestin (as Prempro) for preventing later-life ills. The trial was stopped early, in 2002, because hormone users had a higher risk of breast cancer, heart disease, stroke, and blood clots." http://www.health.harvard.edu/newsweek/What-are-b...

AnnAlive

Fallleaves, thanks. I have reviewed all the article links in this thread.

Here is a pubmed abstract that is a little more alarming, from a study published in 2008, but apparently doesn't mention bioidenticals. This was the HABITS study, and some report it as flawed.

http://www.ncbi.nlm.nih.gov/pubmed/18364505

"Conclusion: After extended follow-up, there was a clinically and statistically
significant increased risk of a new breast cancer event in survivors who
took HT."

Momine, that's the very HRT I was prescribed for menopause in the late 90's: Prempro that combines estrogen and progestin. It was really "pushed" by my OB/GYN as necessary to prevent breast cancer and keep bones and heart healthy. A few years later, I started to have suspicious mammograms leading to biopsies (benign) and eventually invasive bc. Hmmm, do you think they were wrong about the "goodness" of Prempro? I also have osteoporosis now.

Fallleaves

Here's an article that gives pro and con views on HRT (both with scientific support):

http://www.forbes.com/sites/melaniehaiken/2012/10/26/hormone-therapy-whiplash-say-no-to-hrt-say-yes-to-hrt-which-is-it/

Anonymous

Brookside,

I mentioned in a subsequent post that there are at least 20 studies on Pubmed that reflect the same findings, that breast cancer patients do not do worse on HRT after diagnosis. There was a moratorium on HRT studies after the Women's Health Initiative study. That's why there hasn't been any follow-up. But I think there is one study ongoing now out the University of Texas--but that is on bioidenticals. The 20 earlier studies seem to mix bioidenticals and conventional HRT-takers to obtain results.

This is such a big subject and there is so much research to sort out. In Europe apparently they use more bioidenticals in their prescription products so there is existing research on the general outcome. That may be where Kent Holtorf got his data.

AnnLives, I attended a gynecology conference with my sister where The HABITS study was discredited/lambasted by the conventional doctors. I can't remember why but they screwed up several categories in their methods. I would have remembered if I knew someone would ask

Ann, what data does your MO offer against HRT after breast cancer?

Momine

AnnAlive, That really sucks! I remember HRT being a big thing, because it was relevant for my mom. At the time she was entering menopause, and she was considering it for all the usual reasons. 

It was always dubious to me, without the whole BC deal. Menopause is menopause. It is meant to be. If anything is 100% all natural, it is menopause, so I was always loath to mess with that. 

Anonymous

Momine, I completely understand your committment to the natural principle. But bone degeneration is also natural. Would you refuse knee or hip replacement on the same principle? Or blood pressure medication?

BrooksideVT

Thanks, Falleaves.  That article addresses risk factors of HRT for healthy people.  It does not address the effects of HRT on ER+ receptors on breast cancer cells.

AnnAlive

Lucy, my MO didn't offer data, but said hormones, bioidentical or not, can stimulate latent breast cancer cells. The cancer center is affiliated with Moffitt, so I think this is probably the standard of care opinion throughout, not flexible. She was quite insistent. I asked if I could take them for a period of time to get my adrenals to a better place, and she said No.

I know it's my decision whether to take the bioidenticals, but without better data, maybe the risk of recurrence is too great. Other websites have different methods for treating adrenal fatigue, and I will be relieved if the HRT/endocrine doctor offers another method (if it works). My PCP referred me to her when he didn't know what to make of my thyroid labs on Armour thyroid, but the main issue is adrenal fatigue. To my surprise, she started with bioidentical hormones, even after I asked if they are safe after breast cancer. Her practice emphasizes anti-aging medicine. I just want my energy back, but not at any cost (speaking of which -- it is expensive out of pocket with many supplements too). I'm not having hot flashes or the usual menopause symptoms (that was many years ago), but I do have anxiety, irritability, terrible fatigue, etc.  I feel this is all a result of the cancer treatment and surgeries -- wore me down!

BrooksideVT

Well, I went on the University of Texas at Austin site and read an amazing compendium of studies on HRT, all of which addressed risk factors for developing coronary disease or breast cancer, none of which addressed existing breast cancer.  About bioidentical hormone replacement therapy, I found existing studies "are limited, have smaller populations, are shorter in duration, and only evaluate tissue response to hormone exposure."  (Heiss G., Wallace, R.,.Anderson, GL., et al, 2008).  Not promising, not at all.

AnnAlive

Momine -- I do lean toward natural medicine when it makes sense. I had a bad experience with a DCIS diagnosis and alternative treatment that didn't work, which I didn't realize because my alternative doctor at the time (I fired him) followed me up with thermograms only, which never showed cancer going to stage III. That sent me back into conventional world. I'm an RN, so already knew conventional world. I had a hard time finding a doctor on my insurance who would even continue me on Armour Thyroid. I found one who is mostly conventional but somewhat open to alternatives. He's the one who sent me to my HRT anti-aging doctor who has confused me with bioidenticals. I was cooperating until I saw my MO. Uh-oh. Now I see the science is unsettled.

AnnAlive

Brookside - Wow, you're right it's not very promising news for decision-making! And yet oncologists seem so sure bioidenticals are bad for us bc patients. Perhaps I should be more worried about the BHRT doctor who is so sure of her opinion that I'd be safe on hormones at all. It's my health and life she may be putting me at risk.

Thanks, ladies, for your input on the topic. My appointment is Friday morning, and I have to travel some distance to this doctor. I hope I can keep my composure and decide wisely. Good health to you!

Fallleaves

Good luck with your appointment on Friday, AnnAlive. Sounds like you have been burned by alternative medicine in the past, so I certainly understand your reluctance to trust something that has no track record in breast cancer patients. I don't think we are going to find any studies of conventional or bioidentical HRT use for women who have (or had) BC. After the WHI study in 2002, that was such a game changer, I doubt anybody would try a study of HRT on women at risk of BC, much less on those having BC. I will leave you with one last link, to a Global Consensus Statement on a Menopausal Hormone Therapy (MHT), that states that the main risk of BC from MHT comes from the addition of progestogens to estrogen, but it is a small risk that decreases after treatment stops. However the paper also states that the use of custom compounded bioidentical hormones is not recommended, and MHT is not recommended for breast cancer survivors. 

http://www.menopause.org/docs/default-source/2013/ims-ht-ps-2013.pdf

Momine

Ann, wow! Yes, thermography is not reliable, from what I have read. I am glad you caught it at stage 3 at least. Was the alternative doc an MD?

Lucy, to me there is a difference between drug-induced youth on a systemic basis and addressing specific problems of aging should they arise. I already have some bone loss on my spine, and it is likely to get worse thanks to the AI I am on. I am doing my best to slow it, by exercising and eating a healthy diet. I also have bad knees, which are now getting distinctly arthritic. If the cancer doesn't catch me first, I may well need knee replacement in the future to remain mobile. Then again I may not. I will not take replacement hormones in anticipation, and certainly not when I am on meds specifically to starve my body of hormones. But even if I did not have the cancer to consider, I am quite sure I would skip the HRT.

SelenaWolf

HRT - bioidentical or not - simply does not make sense for someone with a hormone-sensitive breast cancer until more clarity is provided.  I, frankly, trust my oncologist to know her stuff and if she does not recommend it, especially given the lack of consensus and understanding of the long-term "domino-effect", than I am very comfortable with that.   Our bodies were simply not designed to produce estrogen (or process introduced estrogen) after menopause. 

Aging is an inevitable part of life and I am content to deal with age-related issues when- and if they arise.  That doesn't mean that I'm not going to try to be as healthy as I possibly can as I age, but it does mean that I am not about to resort to treating a problem medically that does not yet exist with something that my body is, naturally, trying to decrease unless there is a really, really, really good reason to do so.  And the lack of clarity- and consensus on the benefits of HRT for former breast cancer patients simply makes it way too risky for me.

AnnAlive

Momine - yes, my former alternative/holistic doctor is an MD, and also uses some conventional medicine. I was making good progress with thyroid replacement (Armour) he had started me on, so I trusted him to "try" the natural cancer treatment and thermograms for follow-up (because he said mammograms--and I have had many--cause cancer). Big mistake. First thing the breast surgeon said when biopsy results were in was "you've been misled." Now I worry I've been misled again into BHRT that is too risky for me.

Selena - my own cancer was not hormone-sensitive, but my MO says the risk is still there because recurring cancer can change receptors and become ER+/PR+. I'm not seeking youth (age 62) -- I just want to get over adrenal fatigue to have a better quality of life. BHRT seems to be wrapped up in the anti-aging movement, not just a temporary means of getting through menopause.

I've pretty much decided to refuse further BHRT at my appointment tomorrow. I've only had a couple months of it. I'll hear her out, but I already know her opinion. She should hopefully back down because of my recurrence concerns (even if she disagrees) and present an alternative. If she can't, I guess I'll be seeking other adrenal/thyroid remedies or doctors.

SelenaWolf

Good luck, AnnAlive.   I've only read sparingly about non-hormone driven cancers, so thanks for that input.

Momine

Ann, I am very angry on your behalf. I hope you reported that doctor to the medical board. That sounds really irresponsible what he did. If too many mammos are a concern, there is always U/S.

Good luck finding a solution to the fatigue.

BrooksideVT

AnnAlive, I never heard of Armour thyroid, so googled it.  While it sure sounds superior to synthroid (which I just learned I may be taking in a few months), the documentation indicates that caution needs to be used when adrenals are not at their best.  Probably synthroid has a smilar caveat.  Could this be why your alternative doc wanted you to use BHRT?  Would an endocrinologist be of any help here?

AnnAlive

Momine - it's known by my BS that others patients of that doctor have presented with advanced cancer after relying on thermograms. There were no medical board complaints against him at the time, and I was too overwhelmed to pursue all the documentation it would require. DH and I did get legal counsel and it was thought to be a case I wouldn't have won, partly due to Florida law.

Brookside - Armour Thyroid has been the most popular natural desiccated thyroid (in the US) for decades and requires a prescription. Other good brands I have taken are Nature-throid and Erfa Thyroid (Canada). These are reported by patients to be so much better than the T4-only synthetics such as Synthroid or Levoxyl that the conventional docs prefer-- and many will not prescribe natural. Armour includes T3 and T4 (too much to explain here). 

Yes, the adrenals are supposed to be functioning normally first, before taking thyroid meds, and it's a mistake that many doctors make -- starting thyroid before checking adrenal function.  Mine didn't check either, but my adrenals might have been OK when I started Armour 5 years ago. After chemo, rads, and several surgeries, I'm wiped out and have low adrenal function. I would do worse on increased doses of thyroid before improving the adrenals. The anti-aging doctor I'm seeing now (tomorrow!) prescribed progesterone & DHEA (precursor to estrogen & testosterone). When my PCP sent me to her a few months ago to sort out my adrenal fatigue, I didn't know bioidenticals would be in her plan for me, because I have read about other adrenal support (diet/herbs). She assured me they are safe post-bc. 

Endocrinologists are usually very conventional and will prescribe synthetics -- I'm avoiding going to one after reading other patient experiences.

I've gone a little off-topic, but low adrenal/thyroid is the reason I'm being given bioidenticals, even after bc. It's probably not safe, or we don't have enough data to know! It may be a challenging appointment tomorrow, and I'm nervous.

AnnAlive

The appointment with my alternative doctor worked out well, and she pointed out data from Dr. Philip Sarrel at Yale about safety of bioidenticals. Still, for my comfort level (to avoid conflict with my MO), we are migrating to another part of her overall treatment plan for restoring adrenal/thyroid health. I have stopped progesterone (as my MO advised) but will continue with bioidentical DHEA cream for now because my levels are so low. Meanwhile, my alternative doctor started me on some high quality herbal adrenal support supplements. I hope to see a difference in fatigue soon.

May we all have a healthier, more energetic 2014!

Momine

"May we all have a healthier, more energetic 2014!"

I will certainly drink to that.