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[Hurdity]

This has just come to my attention - an interesting article - review - in the journal of the British Menopause Society (Post Reproductive Health) entitled:

"Progestogens are the problem in hormone replacement therapy: Time to reappraise their use" by  Manyonda et al.

https://journals.sagepub.com/doi/full/10.1177/2053369119876490

Abstract

"Combined (estrogen and a progestogen) hormone replacement therapy (cHRT) is associated with an increased risk of breast cancer, while estrogen replacement therapy is not. Whatever the underlying mechanism, it is the progestogen in cHRT that seems to increase the risk. Fear of breast cancer is a major limiting factor in the use of hormone replacement therapy, and when women discontinue cHRT because of side effects, the latter are often attributable to the progestogen component. cHRT is given to women with an intact uterus to protect against the effects of un-opposed estrogen such as an increased risk of endometrial cancer. Estrogen replacement therapy suffices for women with a prior hysterectomy. There is a clear distinction in risk and side effect profile between cHRT and estrogen replacement therapy. Apart from being the most effective treatment for menopausal symptoms, estrogen prevents osteoporosis, and may also have a potential role in prevention of Alzheimer's Dementia, now the biggest killer of women in the United Kingdom. Evidence also suggests that progestogens could compromise the dementia-preventative effect of estrogen. Given the immense therapeutic and preventative potential of estrogen, the use of progestogens in cHRT needs re-appraisal. The levonorgestrel intrauterine system (LNg-IUS) could reduce breast cancer risk while protecting the endometrium. Other approaches to the safe use of progestogens await research."

The full article is open access at the moment.

Hurdity x

[Sgtvhilts]

Good post.
I wouldn't surprise me at all that progesterones are found to be the 'bad guys'.  We (me and prog) have hated each other since puberty! only one type i get on with.  I woudl say progest. is an extremly powerful substance/hormone.  It drives me quite insane.
Going forward, how do we get around it.  I don't fancy a hysterectomy, but you never know............... i don't need my uterus any more, so like my gall bladder- the bin.

[shrosphirelass]

Thanks Hurdity, very interesting.

[jillydoll]

Yes thanx Hurdity.
Interesting post and article...x

[sheila99]

Interested in the following extract 

In search of other potentially safer approaches to the use of progestogens, it has been suggested that the so-called bio-identical progestogens could be safer, or the periodic (every three to four months rather than monthly) administration of a progestogen reduces breast exposure, but there is no robust evidence of a reduction in breast cancer risk with these approaches.

I hadn't heard of a 3-4 month cycle being an option. Does anyone know anything about it?

[Hurdity]

sheila99 - there is a proprietary brand of HRT which involves a 3 monthly cycle - Tridestra although it is billed as for late peri when periods are few and far between. Four months is pretty long though! There was a trend towards off-licence 3 monthly regimes a few years ago and several private gynaes were prescribing this way. However there was a study done looking into 3 monthly regimes which I believe was possibly halted due to the incidence of endometrial hyperplasia or maybe even cancer. I'm not sure at the moment and don't have time to look! However it fell out of favour and prviate gynaes began to prescribe shorter duration progestogen regimes on the usual monthly cycle (notably a la Studd). However these too are associated with endometrial hyperplasia especially the 7 day regimes. It would be good if the longer cycle regime was revived and given proper study and licensing, and especially if along with that women were given annual scans on NHS ( tall order though!). Also long cycles are probably only likely to work on low to medium dose oestrogen as otherwise the lining could thicken and break away spontaneously before the 3 months has elapsed which is not the idea!

Hurdity x

[sheila99]

I thought it might be too good to br true    I can cope with the 12 days but every 3 months would be sooooo much better. Tridesta is oral so not sure there's much to be gained.

[Mary G]

I think that the progesterone part of HRT is a problem for many women and the reason why so many women give up on HRT altogether.   Better forms of body identical progesterone need to be more readily available. 

This link is about the risks of synthetic progesterone versus body identical progesterone:

https://www.bmj.com/content/367/bmj.l5928/rr-3

This is from CRUK:

https://scienceblog.cancerresearchuk.org/2015/07/08/solving-a-breast-cancer-mystery-why-do-double-positive-women-do-better/

It would seem it is the synthetic progesterone component in HRT that slightly increases the risk of breast cancer.

[Ladybt28]

For ladies who may wish to consider Tridestra….

I have had one course of Tridestra and my GP knew all about it and suggested it so, it's not just private gyneas.  That was in Feb 17 I think.  It is oral and it caused me nausea, the runs and I found the progesterone phase difficult but I have to say that it was given to me at a time when I had changed my hrt 3 times quite quickly so it probably wasn't a good test run as I was so bad anyway I didn't know if I was coming or going!  I would have had to have had 2 lots of the 90 days to find out if it really was going to settle.  It was sort of taken out of my hands because I landed in hospital with sepsis within the next month or so and they stopped my hrt altogether anyway.  Its hard to remember the timing of all this stuff to honest, I think I have it written down somewhere!?    So I was 56 at the time and my GP nor I knew whether I was in full meno because had been on hrt sine 46 ish but she assumed I was post meno and she was happy to prescribe.

The idea is good but if you suffer with issues from taking pills then you will be likely to have them on Tridestra.
There are 91 tablets in a pack of Tridestra. From days 71 to 84, you will be taking blue tablets, containing estradiol 2mg and medroxyprogesterone 20mg. From days 85 to 91, you will be taking yellow tablets with no active ingredient. You will get a withdrawal bleed whilst taking these yellow tablets.
It isn't on a shortage list either, at least I don't think it is if anyone wishes to try it. xx

[Ljp]

Having tried utrogestan for a month orally and feeling foggy and mood swings and low mood generally, I've now tried two nights vaginal route and although feeling less foggy, I'm feeling sore externally, was worried it might aggravate my VA and it seems that might be the case...seeing gynae/menopause specialist if Tuesday, I think my mind is made up now, I'll have my mirena replaced.... who knows what further research and/or options might be available in another 4-5 years

Can't help but think there's  so much more that potentially increases risk of breast cancer and Alzheimer's though, not  just cHRT. Other life choices like diet, obesity, smoking etc all play a part I'm sure

[Hurdity]

I thought it might be too good to br true    I can cope with the 12 days but every 3 months would be sooooo much better. Tridesta is oral so not sure there's much to be gained.

Hi I didn't want to give the impression that all is lost re longer cycles - the point of the paper is that in view of increasing info about breast cancer and the progestogen component of HRT the suggestion was made that the idea of longer cycles might be revisited. I just wanted to say that it's not a new idea and many gynaes actually still do favour it - well at least longer than monthly.

The fact also that there exists a propietary brand of HRT (Tridestra) taken on a 3 monthly cycle ( albeit oral) means that the idea is already in existence, is what I meant. It's just there seems to be a reluctance to prescribe other regimes on this basis - so there needs to be research on the minimum dose/duration (on average) necessary to prevent endometrial hyperplasia in relation to different length cycles. For example the dose of MPA in Tridestra (20 mg) is double that of the monthly cyclical dose ( 10 mg). It may well be unpalatable for women to take such high doses (eg double the usual oral dose of cyclical utrogestan would be 400 mg), so again research into vaginal use at different doses and different length cycles is needed.

Yes Ladybt - I didn't mean that Tridestra was only prescribed by private gynaes it was just the private gynaes tending to be more flexible about the off licence 3 monthly regimes I was referring to ie the separate oestrogen and progestogen regimes. Umnless you are very late peri or post-menopause then you could get bleeding before te 3 months is up.

Sorry if my post is confusing - I'm v busy so posting in a bit of a hurry these days!

Hurdity x