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Hormone therapy for menopausal symptoms

BMJ 2012; 344 doi: https://doi.org/10.1136/bmj.e815 (Published 08 February 2012) Cite this as: BMJ 2012;344:e815

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Re: Hormone therapy for menopausal symptoms

Helen Roberts makes the dubious comment that healthy women have a low absolute risk of adverse events, whether they use hormone treatment during early menopause or not.1 Hormone proponents are reluctant to recognise how quickly hormone use can cause cancer.2,3

The much publicised objections to the results of the Collaborative Re-analysis, the Women’s Health Institute Study and the Million Women study seem to stem from the belief that breast cancers take 5-10 years to become detectable clinically. This estimation was based on a simple cellular model which is not applicable to more solid tumours which have tissues, blood vessels and a wide range of growth rates.3 Hormonal carcinogenesis can be much more rapid than cancer due to X-ray damage because thousands of genes are up or down regulated, cellular and liver safety mechanisms are impaired, and, instant vascular changes can increase metastatic spread.

Introducing mammography screening produced an increase in registrations because very small tumours could be detected earlier. When screening programmes became established, with a new smaller size at diagnosis, the numbers returned to the previous rate of underlying increase.2

Contraceptive or HRT hormone studies underestimate risks when the majority of women have taken progestogens and oestrogens for one reason or another before enrolment. Adding progestogens to oestrogen HRT to prevent endometrial cancer caused more breast cancer in combination users than in oestrogen only users. The latest biochemical contortions in the attempts to resuscitate HRT involve using conjugated oestrogens together with the oestrogen receptor modulator bazedoxifene which was derived from raloxifene. However, the incidences of vasodilatation (hot flushes), leg cramps, and venous thromboembolic events were significantly higher with both bazedoxifene and raloxifene given alone compared with placebo.4 As oestrogens given alone increase the risk of venous thromboembolism prolonged use of this combination to prevent osteoporosis and hot flushes is questionable.

For 80 years experimental animal models have demonstrated that hormone-induced cell proliferation plays a critical role in hormone-initiated carcinogenesis.5 For the past 50 years increases and decreases in hormone use have rapidly produced corresponding changes in breast cancer incidences.2

It is simpler and safer to replete low white cell zinc, low red cell magnesium, low serum copper levels and vitamin D deficiency to prevent osteoporosis, menopausal vascular over-reactivity and mood changes. Adverse reactions to food (including masked allergies), smoking and alcohol use also need to be avoided. Good health is priceless. ellengrant@talktalk.net

1 Roberts H. Hormone therapy for menopausal symptoms. BMJ 2012;344:e815 (Published 08 February 2012)

2 Grant ECG. Re: Articles disputing link between HRT and breast cancer are “ridiculous”. BMJ (Published 25 January 2012)

3 Johnson AE. Bennett MH, Cheung CWD, et al. The management of individual breast cancers. The Breast 1995; 4: 100-111. p3

4. Kawate H, Takayangi R. Efficacy and safety of bazedoxifene for postmenopausal osteoporosis. Clin Interv Aging. 2011;6:151-60.

5. Li JJ. Perspectives in hormonal carcinogenesis: animal models to human disease. In Cellular and Molecular mechanism of Hormonal Carcinogenesis: Environmental Influences. Eds James Huff, Jeff Boyd, J Carl Barrett. Biological Progress in Clinical and Biological Research 1996;394:447-454. Wiley-Liss.Inc.

Competing interests: No competing interests

17 February 2012
Ellen CG Grant
Retired physician and medical gynecologist
Private Practise
Kingston-upon-Thames, KT2 7JU, UK