What is hormone therapy? First, let’s get the terminology down. There are several different types of hormone therapies out there. From thyroid hormone replacement, to testosterone replacement for “low T” in men (also known as andropause by the way), to the commonly referred to female hormone replacement therapy (HRT). Typical HRT in conventional medicine is the replacement of estrogen in an oral or topical synthetic form. Your doctor may prescribe this for symptoms of low estrogen, such as hot flashes, during the transition through menopause and then beyond in post-menopause. In this case, it is known as Menopausal Hormone Therapy (MHT).

In the last decade, new information has linked a possible increased risk of breast cancer and in women with a history of HRT use. So it is not recommended frequently as a viable treatment in peri or postmenopausal women who are breast cancer survivors.

Health practitioners knowledgeable in natural therapeutics, such as naturopathic doctors or functional medicine doctors, have long been using bioidentical hormone replacement therapy (BHRT) with fewer risks but all the benefits of MHT or HRT.


Does hormone replacement therapy cause breast cancer?

Hormone replacement itself does not cause cancer. The current research shows a connection with HRT use and breast cancer for some but not others. According to the National Cancer Institute, in breast cancer survivors, 2 studies showed an increased risk of recurrence and 2 showed no increased risk. There are many variables to consider that could create a situation where cancer growth is more likely. These variables include a person’s health history (ie; history of breast cancer in the past), genetics, environmental exposure, nutritional status, lifestyle, mental and emotional well-being, as well as the type of HRT used and how it is delivered.

As a rule of thumb, I do not use any estrogen therapies in women with a history of estrogen receptor positive breast cancer. Nor I do use any progesterone therapies in women with a history of progesterone receptor positive breast cancer. 


What are the risks and benefits of hormone replacement therapy?

Obviously symptom relief is why many women seek out HRT. Symptoms such as, uncomfortable hot flashes can be very disruptive. Especially, since our society values youth, some women may feel embarrassed when a hot flash comes on in the middle of an important meeting at work for example. 

Although HRT is effective for hot flashes, the body of research shows few other benefits of conventional HRT (synthetic estrogen/estrogen+progesterone). The Women’s Health Initiative (WHI) with 27,000 healthy women between 50 to 79 years of age, showed a reduction in hip and vertebral fractures with HRT use. In this particular group, synthetic estrogen-only HRT showed a decreased risk of breast cancer but synthetic estrogen + progesterone showed an increased risk of breast cancer. Otherwise, the risk of heart disease (blood clots and heart attacks), dementia, incontinence, and vaginal bleeding all went up.

Conversely, using Bioidentical Hormone Replacement Therapy (BHRT) can have much lower risks if used correctly. For example, there are studies that show clearly the link between synthetic progesterone use and increased breast cancer risk, whereas bioidentical progesterone clearly shows a decreased risk of breast cancer.


What is the safest way to use HRT?

So should you give up on the idea of using HRT? In my practice, specializing in women’s health and hormones for over 14 years, it really boils down to the individual and the proper use of hormone therapy. By proper use, I mean testing the hormones to see which ones are low (and why) and then temporarily using hormones to help with symptoms while addressing the underlying cause. This entails a salivary adrenal and hormone laboratory panel.

Additionally, since most women are estrogen dominant (low progesterone to estrogen ratio) due to a little-known effect of stress on the female hormone system, in my opinion estrogen therapy is not the way to go. Estrogen dominance increases the risk of breast cancer and other health issues which is why some doctors recommend an estrogen + progesterone combination. 

However, as we have seen, synthetic estrogen+progesterone combinations increase risk as well. In fact, many women do not need any estrogen and do better with a bioidentical progesterone-only preparation. For women who do need estrogen, using a combination of low-dose bioidentical estrogen in a gentle formulation of 80% estriol and 20% estradiol in combination with bioidentical progesterone is ideal.


So with proper testing and monitoring, as well as, the temporary use of bioidentical hormones, this is a very safe and effective therapy consideration for most women. If you would like to discuss your options for BHRT, schedule a free consultation.