Estrogen Matters: Why Taking Hormones in Menopause Can Improve Women's Well-Being and Lengthen Their Lives -- Without Raising the Risk of Breast Cancer (2024 Revised and Updated Edition)

by Carol Tavris

Memory exercises are today’s mental weights; accordingly, numerous online programs are available to help people strengthen working memory, one of the mental systems responsible for storing and manipulating information. Working-memory training originated in 1999, when cognitive neuroscientist Torkel Klingberg created a computer program designed to help children with ADHD learn to focus. By 2001, he launched his company, Cogmed, and initial studies of children with attention deficit problems were promising.

Just as with estrogen’s benefits for heart and bones, there does seem to be a window of opportunity for estrogen to have a long-standing cognitive benefit: the decade following the onset of menopause.

The WHI’s own data showed that women who had taken hormones prior to entering the study, and therefore closer to the time of menopause, were less likely to develop all forms of dementia, including Alzheimer’s, during the clinical trial. They had a reduction of risk of 50 percent compared to nonusers.80 We hope that information persuaded Linda’s doctor, as, along with decades of supporting research, it has persuaded us.

(This problem—of participants in any study knowing whether they are getting the real drug or a placebo—afflicts much research, even gold-standard RCTs and the Women’s Health Initiative. In studies of menopausal symptoms, a woman will know soon enough what she’s taking.)

And remember that even if HRT with progestin increases the risk of breast cancer by 2 percent, we have bombarded you with evidence that women on HRT live longer and have a lower death rate from breast cancer than those not taking HRT.

the rate of developing colon cancer is consistently lower for women, especially premenopausal women, suggesting that estrogen protects against the growth of cancerous cells in the colon.15 Over the decades, numerous researchers have found that women who take HRT in pill form (as opposed to the transdermal patch) have a lower risk of getting colon cancer and a lower mortality rate from colon cancer if they do get it as compared with women not on hormones.

oral contraceptives, ethinyl estradiol comes in a variety of dosages. Some are higher than the dose used in HRT, and some are lower. Some low-dose oral contraceptives contain only 0.01 milligram of ethinyl estradiol and tend to be prescribed primarily for perimenopausal women who want contraception but who also have irregular or heavy menses or hormonally related symptoms that impair quality of life. These preparations provide adequate estrogen to relieve hot flashes and other vasomotor symptoms.21 (The progesterone components of birth control pills and HRT are often similar.)

Throughout the 1980s, a series of large-scale studies from the Centers for Disease Control’s Cancer and Steroid Hormone (CASH) Study repeatedly found no significant association between oral contraceptive use and breast cancer, even when it was used at an early age, before first pregnancy, at the time of diagnosis, or in women with a family history of breast cancer.

As with other findings about estrogen, survival rates for

breast cancer patients tend to be higher in women taking oral contraceptives at the time of their diagnosis than in women not taking estrogen.

But wonders never cease, and progress marches on. In January 2018, the Women’s Health Initiative investigators announced that the dose of estrogen in vaginal creams is not associated with an increased risk of breast cancer.39 It took them only sixteen years, so who knows—maybe in another sixteen years, they will change their minds about HRT too.

there has been no decline in breast cancer rates among black women. Besides, the overwhelming majority of women who take HRT do not develop breast cancer, and the overwhelming majority of women who do develop breast cancer do not take HRT—and you have no evidence that the decline occurred only among women who had been on HRT and stopped. And by the way, in Norway, where women went off HRT following the Women’s Health Initiative at the same rates as here, there was no decline in breast cancer. How, then, can you claim credit on behalf of the WHI for a decline in breast cancer rates in America but not Norway, and only among white women?”

Discussing the abrupt termination of the WHI, Marcia Stefanick said, “Maybe we didn’t need to do it that way. It wasn’t an emergency—it wasn’t like people were, you know, under serious threat of the adverse outcomes.” She waited five years to say this? The entire thrust of the WHI’s first announcement was that there was a “serious threat” to women of adverse outcomes.

For example, in a 2012 article published in Lancet Oncology, the WHI investigators were already backtracking on their claims about estrogen and breast cancer. Women on estrogen alone, they reported, were less likely to die of breast cancer—indeed, less likely to die from all causes after a breast cancer diagnosis—than women assigned to placebo.

JoAnn Manson’s assessment in 2015, in which she wrote that while she still believed that HRT increased the risk of breast cancer, she was willing to agree that the risk was “offset”

by the protection HRT affords against bone fractures, diabetes, and endometrial cancer.

“We can reassure women now,” she told the Times (UK). “Even though there are risks, there are counterbalancing benefits that mean the effect on mortality is neutral.”7

The WHI rushed into publication without most of the co-investigators even having seen, let alone approved, the final paper that was submitted to JAMA.

The WHI’s finding that HRT increased the risk of breast cancer—the principal reason the study was halted prematurely—was not statistically significant. Yet a few of the WHI’s primary investigators decided that breast

The study’s sample was not representative of menopausal women; their average age was sixty-three.

The study’s sample was not representative of healthy women. Nearly half were current or past smokers; more than a third had been treated for high blood pressure; fully 70 percent were seriously overweight or obese.

Women taking only estrogen had no increased risk at first; three years later, being on ERT was associated with a lower risk of breast cancer.

For these reasons and many others, the North American Menopause Society issued a 2017 position statement noting that “hormone therapy does not need to be routinely discontinued in

women aged older than 60 or 65 years and can be considered for continuation beyond age 65 years for persistent vasomotor symptoms, quality of life issues, or prevention of osteoporosis after appropriate evaluation and counseling of benefits and risks.… There are no data to support routine discontinuation in women age 65 years.”20 This position statement was endorsed by the following groups: Academy of Women’s Health American Association of Clinical Endocrinologists American Association of Nurse Practitioners American Medical Women’s Association American Society for Reproductive Medicine Asociación Mexicana para el Estudio del Climaterio

Association of Reproductive Health Professionals Australasian Menopause Society British Menopause Society Canadian Menopause Society Chinese Menopause Society Colegio Mexicano de Especialistas en Ginecologia y Obstetricia Czech Menopause and Andropause Society Dominican Menopause Society European Menopause and Andropause Society German Menopause Society Groupe d’études de l...

International Osteoporosis Foundation International Society for the Study of Women’s Sexual Health Israeli Menopause Society Japan Society of Menopause and Women’s Health Korean Society of Menopause Menopause Research Society of Singapore National Association of Nurse Practitioners in Women’s Health Società Italiana della Menopausa Society of Obstetricians and Gynaecolog...

My position is that women who begin HRT during menopause for symptoms that seriously affect the quality of their lives have no reason not to take it for as long as it’s beneficial and for as many years as they wish—under the guidance of their physicians, of course.

But HRT isn’t something a woman can start, stop, and resume every few years.

There is a window of opportunity, roughly defined as the first ten years after a woman’s last menstrual period, during wh...

Why not take statins instead of HRT to protect my heart? As we discussed in chapter 3, heart disease kills up to seven times as many women each year as breast cancer does (300,000 versus 41,000); in every decade of a woman’s life after age thirty, heart disease is responsible for more deaths than breast cancer. Being on ERT or HRT can reduce the risk of acute cardiovascular events and death by up to 50 percent.

The number of female deaths annually in the United States associated with osteoporotic hip fractures is approximately the same as the number of deaths from breast cancer.

First and foremost, the WHI has walked back virtually all of their early alarmist findings. In recent publications, they reported that estrogen does not increase “all-cause mortality” or deaths from heart disease and cancer. Actually, they said, it increases longevity, most notably when begun within ten years of the last menstrual period.

in the most striking about-face from their 2003 headlines that HRT “did not have a clinically meaningful effect on health-related quality of life” for women in menopause, they stated in 2019 that “Hormone therapy is the most effective treatment for managing menopausal vasomotor symptoms.”

As for women’s deep-seated fears of breast cancer as their main reason to avoid estrogen, in 2020 the WHI investigators reported a 23% decreased incidence of breast cancer among women randomized to estrogen—after nineteen years of follow-up.

The women on HRT did not have an increased risk; the control group had a reduced risk, because many of the women in that group had been on estrogen before the study!