Hi, Musicandstars
I don't have personal experience of Tibolone but have spent a lot of time over the years reading up on breast cancer risk factors. I'm sorry you have the worry of recently screen-detected increased breast density, which
is linked with increased risk of developing breast cancer, as you say. My understanding is that it also makes interpretation of mammograms more difficult, so that abnormalities may be detected later than in women with breast tissue of average density. Please understand that I'm not trying to worry you further here, but it's a situation that many of us face & have to make decisions about.
My understanding is that there is still considered to be an increased breast risk with Tibolone, but (from memory) less data than with some other forms of HRT, so the picture is perhaps more uncertain. From what I remember, Tibolone is associated with increased risk of
recurrence in women with a prior history of BC, which doesn't apply to you, I know, but does seem to me an indication of potential for harm to the breasts in general. You may already have come across this & be happy with it, in which case please ignore me!
There seems to be consensus on minimal exposure to exogenous progesterone being the safest course of action as regards breast risk, so that sequential regimens are favoured over continual prog use. Part of the mechanism is thought to be that a cycle allows breast cells to slough off as they do in fertile years, reducing the tendency to over-proliferation that can be implicated in development of malignant disease. So I don't think I would swap to a conti regime in these circs.
Your transdermal oestrogen & sequential Utrogestan regimen seems to be the current "gold standard" recommended for minimising breast risk from HRT, though different studies draw different conclusions about the various forms of progesterone, so you are in a difficult situation.
Is it imperative that you continue on HRT, or could this be a sensible point to try tapering off to see whether you still need it?
In my experience, breast surgeons are some of the most open-minded clinicians when it comes to HRT use - this surprised me at first, but of course they have good reason to keep up to date with the latest research & are frequently faced with menopausal breast cancer patients, so know the havoc being without HRT can wreak on our lives. Given your consultant advised you to think very carefully about your HRT use in the light of your mammogram findings, I think you're very wise to do this. I would urge you to read around as much as you can while you're trying to decide, so that you're as well informed & confident as you can be in whatever you choose to do. I wonder whether you might find it easier to decide if your breast clinic were open to a consultation where you could ask further questions. If this feels as though it might be helpful, perhaps you could contact them direct & ask for another appointment or ask your GP to refer you back?
Sorry not to have something more encouraging to say, especially in response to your first post, but having faced a similar dilemma I know how important it is to make the best choices we can. I do hope you manage to make sense of the mass of information out there. It's a very personal decision & only you know everything that is likely to be affected by whatever you choose to do.
