Is HRT safe? – Lancet Study 29/08/19
16th Sept 2019
Most people are aware of The Lancet. It’s the world’s oldest and most prestigious peer-reviewed medical journal. On 29th August, 2019, it published the results of clinical trials into a link between hormone replacement therapy (HRT) and breast cancer in post-menopausal women. The key question is -is HRT safe?
This is an issue which has troubled women on HRT for decades. The research has often been inconclusive, with very mixed results. The underlying issue is should women continue taking the treatment? There’s no doubt it helps them feel better. But what are the true risks?
First, here’s a brief summary of how a woman’s hormones change after menopause –
If the menopause occurs at the average UK age of 51, you could realistically expect many years post-menopausal. In fact, given modern lifespans, it could mean living more years than those spent as a premenopause adult.
The menopause is defined by an absence of menstrual periods for 12 consecutive months. It is then that a woman knows for certain that the functioning of her ovaries has ceased. After this, she can no longer become pregnant. Also, the ovaries can no longer produce Oestrogen. It is the latter which has such a marked effect on ongoing health risks.
Oestrogen is a woman’s defining hormone, much as testosterone plays an equivalent role in men. It’s oestrogen that determines female characteristics, then it stops, just because you’ve lived a certain number of years.
There are four branches of Oestrogen – Oestrone (E1), Oestradiol (E2), Oestriol (E3) and Oestetrol (E4).
The only one found in post-menopausal women is E1. E3 and E4 significantly occur only during pregnancy.
Oestradiol is the most potent, being a natural steroid produced by the ovaries, and it is the production of this that ceases after menopause. A lack of Oestradiol raises the risk of cardiovascular disease, depression and other mental health problems, and vaginal health issues. Skin composition and fat redistribution are other key factors, as is loss of bone density, potentially leading to osteoporosis.
Is HRT safe?
It’s no wonder, then, that many women seek to prolong their access to Oestrogen for as long as possible. Is it safe to do so? Here is what The Lancet study says, looking at both Oestrogen-only treatment and HRT combined with progesterone. The latter is released during the second-half of the menstrual cycle and during pregnancy. Here is a Lancet summary of the study.
Although a well-conducted clinical trial gives data-driven conclusions, it’s worth looking at comments from notable experts in the field.
The bottom line is that there is a definite link between HRT and breast cancer, supported by one of the most carefully researched studies ever. In knowing of this elevated risk, it’s a woman’s own choice whether to start, or continue with, HRT. What then, are the alternatives?
Because of pressures both physical and psychological, a perfectly natural progression in the life cycle is too often approached with dread, more as an illness than something which occurs naturally in 50% of the population. It shouldn’t be so, and it must not be seen this way.
Fortunately, we now live at a time where there are measures which can be taken to alleviate the symptoms… and influence outcomes.
One of the most outwardly visible symptoms is apparent weight gain. The ‘apparent’ though, is often down to the fact that the menopause occurs at a time of life when we have often become less active anyway. Men see weight gain around this stage, without sudden hormonal changes being necessarily responsible.
A healthy lifestyle
Maintaining a healthy lifestyle will go some way to preventing unwanted weight creeping up on you. If you already follow a healthy eating regime and continue to exercise regularly, you should be able to maintain your lean muscle mass.
With the right diet & exercise advice, you can work miracles in your own home, as long as you have 20-30 minutes to spare most days and some basic equipment, like an exercise mat and light weights. Combine cardio exercise, including walking, with weight-bearing activities for optimal results.
Other postmenopausal risks can be minimised by watching your diet and being aware of where it needs to be supplemented, given hormonal changes. In truth, this is something we should ideally be doing throughout our lives. There is, though, at a time of increased vulnerability, a greater need to monitor our own health.
Ensuring an adequate calcium intake, for example, goes some way to combatting osteoporosis. Your calcium intake should come from plant sources rather than dairy, and not from supplements, such as calcium carbonate. This could contribute to calcification of the arteries, leading to an increased heart attack risk.
Weight management and healthy eating will lessen the risk of heart attacks and strokes in the long-term. Hair and skin will also benefit greatly from optimal nutrition.
For vaginal issues, there are now non-invasive laser treatments available. A single session can be effective.
There is now a growing body of thought which suggests that a diet high in plant-based oestrogen (phytoestrogens) can act as a natural hormone replacement. Although women from other countries experience the same menopausal timeline, those in Japan, for example, experience symptoms differently. Hot flushes are rarer, and there is no Japanese equivalent of this expression. What is the difference? Diet.
The consumption of natural, fermented soy is standard in Japan. Soy is very high in phytoestrogens, in the form of soybeans and soy products. Flaxseed (aka linseed) supplies the most potent phytoestrogens, but soy is more likely to be consumed in quantities to make a difference. It could become the basis of an entire diet and serve as nature’s HRT.
Japan is also a country where the menopause is seen more for what it is, part of the natural life-cycle. That the young tend to revere their elders plays a role in this attitude. Whatever the cause, for after all the physical process is identical, attitude goes a long way towards dispelling negativity. Interestingly, when Japanese women move to the West, their experience then tends to mimic that of women in those countries. Clearly, both dietary and psychological factors come into play.
Although we use celebrities too much as role models these days, there’s now a growing trend for a change in Western attitudes to the menopause. Many of these women traded on their image. Now they are using their influence to talk about ‘the change’ and taking a more positive outlook.
Embrace this new-found positivity! Instead of buying a comfy cardigan and knitting needles, buy the smallest red dress you can squeeze into …then step out and celebrate your future!