Concern about breast cancer risk is one of the most common reasons women hesitate to use hormone therapy. Again, much of that fear traces back to reports from the WHI study in the early 2000s.
Subsequent analyses suggest that the increased breast cancer risk seen in the study may have been partly driven by synthetic progestin rather than estrogen. “Estrogen alone appears neutral or protective against breast cancer in some studies,” says Sara Szal, MD, author of Women, Food, and Hormones.
Observational research studying estrogen paired with bioidentical progesterone has not shown the same risk associated with older synthetic formulations. But researchers note that more large randomized trials directly comparing different types of progesterone are still needed to confirm their safety profiles.
“It’s incredibly important to balance your estrogen and progesterone.”
Estrogen does stimulate tissue growth, including in the lining of the uterus, so women with a uterus are typically prescribed progesterone alongside estrogen therapy. The progesterone helps counterbalance estrogen’s growth-promoting effects and reduces the risk of certain cancers.
“When we think about something like uterus cancer, it’s incredibly important to balance your estrogen and progesterone,” says Karen Kaufman, MD, a board-certified obstetrician and gynecologist, and the medical director of MIORA in Colorado.
Understanding HRT
If you’re considering hormone replacement therapy (HRT), you probably have questions. We asked clinicians and hormone specialists for answers about how HRT works, what its real risks and benefits are, and how to decide whether it’s right for you at “A Balanced Approach to Hormone Replacement Therapy,” from which this article was excerpted.
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