“Thousands of postmenopausal women have died prematurely over the past decade because they avoided estrogen therapy after hysterectomy. The most conservative estimates placed the total number of deaths at 18,601. The toll could be as high as 91,610…. “The finding is so dramatic — reporting thousands of women dying every year — if this gets the attention that it deserves, we hope it will change clinical practice.” *
Quote from New WHI Analysis: This Time Estrogen Saves Lives, Published July 18, 2013,
Medpage Today and David Katz, MD, the Yale-Griffin Research Center.
The Medpage article, shown in its entirety below, stated that “The estimates of premature deaths came from an updated analysis of the Women’s Health Initiative (WHI) Estrogen Plus Progestin Trial, which ended prematurely in 2002 after an interim review showed an increased risk of adverse events associated with combined hormonal therapy. The updated analysis was limited to younger women (50 to 59) who had undergone hysterectomy. In that subgroup of patients, unopposed estrogen significantly reduced the mortality risk.” Philip Sarrel, MD, of Yale University, and co-authors reported online in the American Journal of Public Health.
The FEAR of hormones prevents many women from obtaining the protection of natural hormones against Heart Disease and Breast Cancer.
Natural Bio Health has been providing hormone therapy, including the prescribing of bioidentical estradiol, to its female clients for 14 years. Each of our clinics has served thousands of women in Austin, Odessa, College Station and San Antonio, Texas. We often hear women express their fear of taking hormones because they have “heard or been told by their family provider” that hormones cause breast cancer and increase their risk of heart disease.
These “rumors and beliefs” come from a misunderstanding of the Women’s Health Initiative Study (WHI) published in July of 2002. This study involved only women who were taking combined estrogen (premarin) and progestin (provera). The name of the combined hormone is prempro, which is still being prescribed by some providers today.
This combination (which is in most birth control pills) did cause an increase in the risk of breast cancer and stroke. HOWEVER, the study was NOT estradiol alone and it was NOT estradiol and progesterone, commonly prescribed at Natural Bio Health Clinics.
Hysterectomies and surgical menopause.
The analysis quoted above only addressed women who have had hysterectomies. It is estimated that 54% of women undergo oophorectomy at the same time as hysterectomy. This means that their ovaries are removed along with their uterus (sometimes at a young age). It is often referred to as “Surgical Menopause.” Like menopause, it involves a sudden loss of estrogen. Science has shown us in many studies, the estrogen protects the heart, the brain and the skin. It performs 400 functions in the female body (it is also important for men). Most estrogen is produced in the ovaries. Either removal of the ovaries by surgery or the loss of production of estrogen that occurs in menopause causes loss of this hormone.
Progesterone. Unfortunately, women are also told after a hysterectomy that they do not need progesterone because they no longer have a uterus. Progesterone does protect against uterine cancer but this is only one of its 195 functions. This natural hormone also helps protect against breast cancer, osteopenia and osteoporosis, weight gain, memory loss and many other health issues.
“Not Guilty.” Estradiol and Progesterone DO NOT cause Breast Cancer and Heart Disease.
For years, Natural Bio Health has challenged the concept propagated by traditional providers and The American Society of Obstetricians and Gynecologists that estrogen causes breast cancer and a risk of heart disease. Our clients are shown the more recent data and science behind the benefits of estrogen and the reason why you can take it even after having breast cancer.
For those women who have suffered from breast cancer, we follow the protocol to wait at least five years before prescribing estradiol. Although there is no evidence that estradiol increases the risk of breast cancer, the general consensus is to wait the five years to be assured that there is a “cure” of the breast cancer.
Other factors include whether a patient is pre or post menopause and whether the patient has had chemotherapy and has been put into a post-menopausal state without any estrogen production. A woman without metastasis to lymph nodes, treated with conservative surgery only, is already being exposed to estrogen from her ovaries. These patients are considered to be of no risk for recurrence otherwise the ovaries would have been removed or patient treated with chemotherapy to eliminate the production of estrogen.
Provera (a progestin) increases the risk of breast cancer
The problem is the pharmaceutical companies who make synthetic estrogen and progestins didn’t want you in the past to know it is harmful for you. But now that the Women’s Health Initiative Study results have been published, they have no choice. It is clear that the increase in breast cancer was from the Provera in the Prempro.
As a matter of fact the patients taking only the estrogen, Premarin, had less breast cancer by 30% than those that were in the placebo group that took nothing. They also had less heart disease than the control group.
Estrogen is protective of the heart.
The authors of an article published in Menopause Management, March/April 200, concluded that “Until shown otherwise, women and healthcare providers can feel comfortable that the cumulative data, including the WHI, indicate that estrogen therapy is safe and effective in reducing total mortality and cardio vascular heart disease in women who initiate estrogen therapy in close proximity to menopause.”
A more recent paper reviewed by Robert Jasmer, MD, Associate Clinical Professor of Medicine at the University of California in San Francisco, pointed out that thousands of postmenopausal women have died prematurely over the past decade because they avoided estrogen therapy after hysterectomy. He also noted that a subgroup analysis in 2004 showed a reduction in mortality risk among Women’s Health Initiative Study participants who had undergone hysterectomy and were treated with estrogen alone.
Can women who have had breast cancer take estrogen – YES.
As early as 2004, one year after the WHI published the scare about estrogen and breast cancer, new studies have challenged the WHI study. The J Obstet Gynaecol Can. 2004 Jan:26(1):49-60 published three comments and recommendations: 1. Hormone replacement therapy after treatment of breast cancer has not been demonstrated to have an adverse impact on recurrence and mortality 2. Hormone replacement therapy is an option in postmenopausal women with previously treated breast cancer 3. Prospective, randomized clinical trial results are needed.
Another article in the Journal of Family Planning and Reproductive Health Care concluded: The evidence from the clinical trial (WHI) suggests that unopposed estrogen does not increase the risk of breast cancer and may even reduce it. A third article published in Menopause 2003 Jul-Aug:10(4):269-70 entitled “Estrogen replacement therapy in breast cancer survivors: a matched-controlled series,” concluded that in those selected patients, estrogen replacement therapy relieved estrogen deficient symptoms, and did not increase the rate or time to an ipslateral recurrence/new primary, contralateral primary, local-regional recurrence, or systemic disease.
I can reference dozens of more papers that support the use of estrogen but I don’t want to bore you with all the details. Needless to say, the evidence is there. Estrogen does not increase the risk of breast cancer!
Have you had a hysterectomy? Are you menopausal? Post menopausal?
You should be on Hormones!
Everyone women who has had a hysterectomy and their ovaries removed and every woman after menopause should definitely be on estrogen and progesterone therapy. To name a few benefits, the estrogen helps prevent breast cancer, heart disease, stroke, brittle bones with fractures, and Alzheimer’s, just to name a few. The relief of symptoms of hot flashes, night sweats, memory loss, anxiety, depression, vaginal dryness and frequent bladder infections are just a few of the 400 benefits of estrogen therapy.
Progesterone helps prevent breast cancer, helps with sleep quality, and ensures bone density. It works with estrogen to protect the health of the brain. For those women who have a uterus, it helps prevent uterine cancer.
As with any medication therapy, patients need to be followed up on a routine basis with blood studies, physical exams and thermograms to be confident that there are no adverse side effects or issues with the treatments.
The Medpage Article Reprinted Below
New WHI Analysis: This Time Estrogen Saves Lives
Published: Jul 18, 2013 | Updated: Jul 19, 2013
By Charles Bankhead, Staff Writer, MedPage Today
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner
Thousands of postmenopausal women have died prematurely over the past decade because they avoided estrogen therapy after hysterectomy, a new analysis of a landmark study showed.
The most conservative estimates placed the total number of deaths at 18,601, and the toll could be as high 91,610.
The estimates came from an updated analysis of the Women’s Health Initiative (WHI) Estrogen Plus Progestin Trial, which ended prematurely in 2002 after an interim review showed an increased risk of adverse events associated with combined hormonal therapy.
The updated analysis was limited to younger women (50 to 59) who had undergone hysterectomy. In that subgroup of patients, unopposed estrogen significantly reduced the mortality risk, Philip Sarrel, MD, of Yale University, and co-authors reported online in the American Journal of Public Health.
“The finding is so dramatic — reporting thousands of women dying every year — if this gets the attention that it deserves, we hope it will change clinical practice,” co-author David Katz, MD, the Yale-Griffin Research Center, said in an interview. “We hope that clinicians will start routinely talking to their patients who have had a hysterectomy and bringing up the issue that taking estrogen may save your life. We have data to show that it can save your life.
“Frankly, our paper should do that. It’s not every paper that has the potential to change clinical practice. This one should. It occurs in the context of a growing awareness of the damage we have done by talking women out of all forms of hormone replacement.”
In the 1990s, as many as 90% of women in their 50s took estrogen after hysterectomy, and treatment continued for an average of 4 to 5 years. Multiple studies had indicated that estrogen reduced the risk of bone and heart disease after hysterectomy.
Publication of the WHI results in July 2002 led to a rapid and precipitous decline in the use of estrogen by postmenopausal women, even though the findings included women who were taking combined estrogen and progestin rather than estrogen alone. Within 18 months, half of the women using hormonal therapy had stopped, the authors noted.
A subgroup analysis in 2004 showed a reduction in mortality risk among WHI participants who had undergone hysterectomy and were treated with estrogen alone. A follow-up analysis in 2011 confirmed a decreased mortality risk of 13 per 10,000 per year among hysterectomized women 50 to 59 treated with estrogen.
Despite the positive follow-up results from WHI, prescriptions for all types of hormonal therapy have continued to decline, the authors said. Fewer than one-third of hysterectomized women are using estrogen.
“The decline in estrogen therapy prescription and usage seems to reflect a generalized avoidance of any forms of hormone therapy not supported by the WHI data,” the authors wrote. “This raises the possibility that there has been and continues to be a considerable resultant mortality toll.”
To examine the issue, Sarrel and colleagues undertook a study to calculate the number of premature deaths due to estrogen avoidance by hysterectomized women 50 to 59 since the WHI ended. For a point estimate, they used the 2011 WHI publication, showing a 13/10,000/yr increased mortality in that subgroup of women assigned to placebo.
Overall mortality estimates were calculated from population estimates based on census data, age variability in hysterectomy rates, and different rates of estrogen usage prior to 2002.
Investigators used census data to determine the population of women 50 to 59 from 2002 to 2011, and they used national hospital discharge data to determine hysterectomy rates from 1997 to 2005, with and without oophorectomy. For women 50 to 59, the hysterectomy rate ranged between 33% and 40%.
An estimated 54% of women undergo oophorectomy at the same time as hysterectomy. Before 2002 post-hysterectomy estrogen usage among women without ovaries was 90% and 53% among those with ovaries. Investigators performed separate analyses of mortality associated with declining estrogen use for women with and without ovaries.
Applying the lower estimated hysterectomy rate resulted in a best point estimate over 10 years of 49,128 excess deaths and an extreme low estimate of 22,677 excess deaths. Use of the higher hysterectomy estimate resulted in a best point estimate of 59,549 excess deaths over 10 years, increasing to 91,610 for the extreme high estimate.
Finally, the authors factored in a lower mortality associated with estrogen avoidance for women with and without ovaries. Application of the lower estimated hysterectomy rate resulted in a best point estimate of 40,292 excess deaths over 10 years and a low-end estimate of 18,601 excess deaths.
Use of the higher estimated hysterectomy rate resulted in a point estimate of 48,835 excess deaths due to estrogen avoidance, and a high-end point estimate of 75,125.
“Thus, across a reasonable range of all assumptions, the excess mortality was between 18,601 and 91,610,” the authors concluded. “Using the best available point-estimate values with year-by-year adjustment and adjustment for differential rates of estrogen use among women with and without retained ovaries at hysterectomy, the range was 40,292 to 48,835.”
The results show that clinicians should not be reluctant to prescribe estrogen for women who have undergone hysterectomy and are estrogen deficient, said Holly Thacker, MD, of the Cleveland Clinic.
“It’s not only going to improve the quality of their life but likely the longevity of their life,” Thacker told MedPage Today. “It’s really kind of a game changer, in that we’re not just talking the use of estrogen for the lowest dose for the shortest amount of time for treatment of symptoms. We’re also thinking in terms of prevention and lifespan and quality of life and work productivity.
“Women and their providers need to stop being fearful of treating estrogen deficiency.”
A founder of the North American Menopause Society said the results are part of an ongoing effort to repair damage caused by early reports from the WHI.
“This is not the first paper to demonstrate that the way the WHI interpreted their results and presented them to the media has resulted in far more death and disability than it prevented,” Wulf Utian, MB BCh, of Case Western Reserve University in Cleveland, said by email.
Primary source: American Journal of Public Health
Sarrel PM, et al “The mortality toll of estrogen avoidance: An analysis of excess deaths among hyserectomized women aged 50 to 59 years” Am J Pub Health 2013; DOI: 10.2105/AJPH.2013.301295.