Family History of Breast Cancer
If a woman has a family history of breast cancer, can she take hormones for her menopause symptoms?
Marla asked me this just yesterday:
Hi Steve, I’m going through menopause and having some difficulty. Since my sister had breast cancer and passed away at age 50, along with my Mom who also had breast cancer; most doctors have told me I’m not a good candidate for any hormone replacement therapy including bio-identical. I’m currently taking an older antidepressant to help me sleep. What are your thoughts and any research on my type of situation. Thank you!
Breast cancer is terrifying. It's a big concern for women in menopause, especially those who have a family history of breast cancer.
I'm Not A Doctor
I'll start out by saying that this post is not medical advice.
You should NOT change your medical care based solely on this video.
Further, I'm not a physicians, an oncologist, or a breast cancer specialist, so take what I say with a grain of salt.
My specialty is teaching people about hormones. I know a lot of hormone optimization providers who tend to agree with me about the risks of hormones. These are physicians, nurse practitioners, and PAs who have looked closely at what the studies say. They've come to the same conclusions I have.
The dilemma is real:
On one hand, you may be suffering with:
It's the whole list of menopause symptoms.
The women I've talked with (over 2500 of them) are desperate for a solution. They want something that will help them get their lives back. They've tried herbal remedies. Dressed in layers. They're always turning down the thermostat. Yoga, supplements, and not drinking wine haven't really helped them.
None of those things seem to make a real difference.
Hormones and Breast Cancer Risk
On the other hand, they're worried about the risk of breast cancer.
The women who are most concerned about breast cancer are the ones with a mom or a sister who has had breast cancer. Some of these women, like Marla, have lost one or more loved ones to breast cancer.
Doctors tell them that hormone replacement is off the table for their menopause symptoms. They'll just have to suffer through and wait until those symptoms go away.
By the way - waiting out menopause means at least 7 years for most women!
It's an impossible situation. "Damned if I do and damned if I don't."
What can I possibly say to these desperate, fearful women?
The first thing I have to say to Marla and other women in this impossible situation is . . . "I'm so sorry!"
I can't imagine how hard it must be to lose someone so close to something so devastating. This must be so difficult for you.
To make things worse, menopause symptoms make your life miserable.
I've talked with women in menopause who felt like their lives were just over. They felt like they had nothing left to live for.
That's also heartbreaking.
I've heard from menopausal women who haven't felt heard or seen by their doctor. These women have felt like their concerns have been dismissed.
I met a doctor at a party the other day. As it turned out, he had worked on a team of researchers involved with the Women's Health Initiative.
We started talking about menopause. He joked about telling a woman in menopause, "Get a fan."
Maybe that's the attitude you've heard from your doctor?
It's possible you haven't experienced a lot of compassion for your situation.
If you're the woman who is suffering BOTH the loss of a loved one and AND the struggle of menopause . . .
Your story matters! I see you.
It's impossible for me to say "I understand" because I'll never be in your shoes.
But there are healthcare professionals who have compassion for your pain. There are providers who care.
The Bad News
The Women's Health Initiative was a giant study of hormones for menopause. It was stopped in 2002 because of a perceived increase in the risk of breast cancer. That study has convinced doctors that all hormone replacement is dangerous. You can watch some of my other videos explaining the WHI and what it does and doesn't say.
Since the WHI, physicians discourage women from taking any hormones for menopause. Doctors even deny patients hormones that have been shown not to increase breast cancer risk.
That's deeply sad to me and the healthcare providers I work with. We're saddened because women suffer needlessly for years with horrible symptoms that could be relieved.
The Good News
I work with hundreds of hormone optimization specialists who believe that optimal hormone levels are the single most effective treatment for menopause symptoms.
The evidence favors using just right levels of the right hormones - estradiol and progesterone - to relieve the suffering of women in menopause. Getting your hormones optimized is the best thing for your symptoms and for your long-term health.
Just right hormone levels don't lead to increased risks for breast cancer. When prescribed appropriately, by a provider who really understands them, they can help protect breast tissue from cancer. This is even true for women with a family history of breast cancer.
What If My Wife Had A Family History of Breast Cancer?
You could be asking: "What would you do if your wife had a family history of breast cancer AND menopause symptoms?"
Well, my wife does have a family history of breast cancer.
She also takes estradiol and progesterone to eliminate her menopause symptoms and keep her healthy. She and I feel very confident that it's the best path for her. We've talked about it several times over the past 15 to 20 years
At the same time, we work closely with one of those hormone optimization specialists I've mentioned. He's a provider who's been trained in prescribing hormones. He knows how to monitor them. We're doing our best to make sure her levels are not too high, not too low, but just right.
Some Providers Will Help
There are qualified, experienced healthcare providers who know what they're doing. I know some physicians and nurse practitioners who aren't afraid to help women in menopause by optimizing their hormones.
Not every provider - not even every hormone optimization provider - is willing to help. But some are.
What To Expect
If you find a hormone optimization provider who is willing to help with your hormones, in spite of a family history of breast cancer, here are 4 things you might experience:
- They will ask you for your informed consent. It's important that you understand the risks, up front, based on what the research actually says. A reputable provider will help you understand those risks.
- A hormone specialist may ask you to get genetic testing. Your genes inform your risks. But they are not your destiny. Just because family members have had breast cancer, that doesn't mean you are doomed to have it too. At the same time, understanding your genetic predispositions can be the first step toward helping you avoid breast cancer and other issues.
- Some providers will use a Dried Urine Test for Comprehensive Hormones (DUTCH® Test). This test can be useful in helping figure out how your body "metabolizes" (gets rid of) hormones. Different ways of eliminating hormones from your body ("metabolic pathways") can lead to different risks for breast cancer.
- They may ask you to change your diet and take nutritional supplements. These can encourage your metabolic pathways to move hormones toward "safer" metabolites that can be easily eliminated and away from "harmful" hormone metabolites.
It's Not An Easy Road
In conclusion, if you have both a family history of breast cancer and serious menopause symptoms . . . your path is not an easy one.
There aren't a lot of providers who are willing to help you. But there may be someone in your area. Visit the link that says "Find help with your hormones" and let me know where you live. I can't guarantee I know someone near you OR that providers in your city are willing to help in your situation. But I'll give it my best shot.
If you're a hormone specialist and you're confident about treating women with a family history of breast cancer, I'd love to have you on my provider database. Click the link that says "Join provider database."