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[Hurdity]

This new literature review popped up on my twitter feed. At the moment it's open access so you can currently read/download the whole article. I only had a quick glance through last night but should be of interest to some members. It looks at and summarises all the relevant studies to date.

"The impact of micronized progesterone on breast cancer risk: a systematic review

CLIMACTERIC, 2018
VOL. 21, NO. 2, 111–122

P. Stute, L. Wildtand, J. Neulenc

Postmenopausal women with an intact uterus using estrogen therapy should receive a progestogen for endometrial protection. The debate on bioidentical hormones including micronized progesterone has increased in recent years. Based on a systematic literature review on the impact of menopausal hormone therapy (MHT) containing micronized progesterone on the mammary gland, an international expert panel's recommendations are as follows: (1) estrogens combined with oral (approved) or vaginal (off-label use) micronized progesterone do not increase breast cancer risk for up to 5 years of treatment duration; (2) there is limited evidence that estrogens combined with oral micronized progesterone applied for more than 5 years are associated with an increased breast cancer risk; and (3) counseling on combined MHT should cover breast cancer risk – regardless of the progestogen chosen. Yet, women should also be counseled on other modifiable and non-modifiable breast cancer risk factors in order to balance the impact of combined MHT on the breast."

Hurdity x

[Dancinggirl]

It looks like it's not yet considered any safer than other types of progesterone ? They are basically ‘covering their arses with this statement!!!???  Perhaps I'm not interpreting this correctly?  The five year timescale for HRT seems to be held onto without stipulating when HRT is being used - what about women who have a premature meno???

This seems to add to the trend for GPs to refuse or at least seriously counsel women against using HRT after 5 years, regardless of age or need. When referring to ‘modifiable and non-modifiable' risk factors, do they mean keeping weight under control, drinking less alcohol and stop smoking?

To me it seems the jury is still out when it comes to Utrogestan    DG x

[dangermouse]

As they are referring to Utrogestan (natural progesterone) as a protective to stop Estradiol (natural oestrogen) stimulating both endometrial tissue and breast tissue, I wonder why they don't prescribe it for women without a uterus for breast tissue protection?

I'm sure the 5-20 year thing is more to do with the oestrogen, and that Utrogestan added to it is of no further risk (and is probably protective) compared to synthetic progestins which aren't as protective due to them not being such a true fit.

The synthetic progestogen Norethisterone has been used in high doses to reduce breast growths so adding even synthetic prog does not make tumours grow, it just may not be enough to control oestrogen.

I doubt this will make any difference to NICE recs as it's 5-10 years now but many docs prescribe for much longer.