Endometrial Cancer.  Are you at risk taking hormones?  What are the facts?  What is the science?

Inevitably every day, I get questions about the risks of taking hormones.  The other day was no different except that day the women in front of me broke down in tears as she relayed the story of her appointment with her OB-GYN who she has respected, revered, and believed in for the last 20 years.  After looking at her current pelvic ultrasound showing thickening of the endometrial lining and fibroids probably caused by estrogen she was taking, he told her if she continued to take hormones, he would not continue to see her unless she had a full hysterectomy and ovariectomy because she was setting herself up for cancer.

What is truth in this statement and what is opinion? 

This dilemma is faced by the majority of women on any hormone replacement whether it be bioidentical or synthetic.  When your estrogen is low, you are placed on either a bio- ientical hormone or a synthetic hormone to help increase your estrogen.  Some women are more prone to being more responsive to estrogen than others.  All the women I treat, I also oppose the estrogenic effects with progesterone.  In another blog I will write why I do this.

This story is not uncommon.  Trauma and fear with hormone replacement has been induced in doctors and women since the WHI (Women’s Health Initiative) results were published in 2002.  The next blogs will be directed to the history of hormone replacement in women, the risks, and the benefits supported by valid research articles.   Interestingly the same trauma and fear is also induced in doctors and men seeking hormone replacement therapy, so I will alternate these stories by sex.

The truth can only be found through researching the medical literature.  Most laypeople have no idea how to do this.  I will teach you how so you can be your own advocate because until you believe something and have proof, you will always retain the fear instilled in you by the words you heard.   This is a primordial human response to danger.  You are not alone.  Fear is dissipated by knowledge and your obtaining control of the knowledge. 

How Do You Find the Facts

1. Type your question in the URL on your computer and after your question,  type  “pubmed”  and “nih” and “prospective study”.   This will bring up research articles on your subject.  The reason you do this is you want to learn the facts, not someone’s opinion or their conclusion of the facts.
2. Pick the study title that sounds like it will answer your question.
3. Then look for the follow things:
   1. A prospective study has a hypothesis, ‘a proposed explanation made on the basis of limited evidence as a starting point for further investigation’. This is akin to your asking a question.
   2. The study then lists various diagnostic methods to try to answer the question.
   3. The study must meet statistical criteria for the number of subjects needed to prove the hypothesis. Often studies are not looked at seriously unless they have 50-100 subjects in each arm of the study.
   4. ‘Arms of a study’ are putting people on different protocols and each protocol is called “an arm”.
4. First you read the abstract which is a summary of the research to see if the article is really going to answer your question. If not, choose another article
5. Second, read the conclusion for a fast review of the article
6. Third, read the discussion if you want to know more specifics concerning the study.
7. If you are really brave, read the methods which are also important but may not be understandable to the lay person. I will help you if you so desire.
8. Find another article to read
9. Read at least 5 different articles
10. Decide what you think and then go to your doctor for a conversation.
11. If you get stuck, text me!

So, for the next 3 weeks, I suggest all women look up their questions on thickening of the endometrial lining while on estrogen and progesterone replacement therapy in the post menopausal female.   I will do the same and present what I find in 3 weeks.  I would love to hear what your conclusions are so please text me any time!  If you want to discuss what you find, please call for an appointment to do so.

Next week, I am going to pose a similar story and question concerning cardiovascular disease in men on testosterone replacement.  I am going to go into depth with this research as it is critical to understand as a man.

Enjoy the snow!!  Be grateful for the seasons and all the variety of life we have on earth.  Have an awesome day.    Dr. D