Estrogen and Breast Cancer – A Bad Rap That’s Time to Get Right

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estrogen-windowThe safety of estrogen therapy is a hot topic that many women have a lot of questions and concerns about. Dr. Machelle (Mache) Seibel, who is a global leader in women’s wellness and menopause, wants to clear the confusion and set the record straight about the benefits of estrogen for women’s health.

We were fortunate to have Dr. Seibel on our Essentials of Healthy Living radio show last year, and are very excited to have him on the show again in May. He will be discussing his new bestselling book, The Estrogen Window: The Breakthrough Guide to Being Healthy, Energized, and Hormonally Balanced – Through Perimenopause, Menopause, and Beyond.

Below, Dr. Seibel presents a great overview of the latest research on menopausal hormone therapy.

In early 2002, estrogen was the most prescribed medication in the United States. It treated the symptoms of menopause and appeared to have benefit for heart health. Then in July of that year, the large government funded Women’s Health Initiative (WHI) study reported that taking a pill that contained estrogen plus a synthetic progesterone called Provera caused an increased risk for developing breast cancer. Women and many of their doctors grew understandably fearful and estrogen got a bad rap.

I know because I am a leading expert in women’s wellness and menopause, and also because 7 months after that report, my wife was found to have the BReast CAncer (BRCA) gene mutation and had surgery that threw her into early menopause. Her doctors didn’t want to give her estrogen. In addition to needing to know for my patients, I needed to know to help my wife.

The outcome of my investigation is good news for women’s wellness. After reanalyzing the original WHI study and with the aid of many more studies since, it’s clear the original well-intended but misguided studies got it wrong. Estrogen can be safely used to help most women.

That’s why I wrote my new book The Estrogen Window. It’s #1 on Amazon in menopause. There are 11 pages of index so you can learn about exactly what is worrying you. I’m going to focus here on some important points about estrogen and breast cancer.

First, how did the 2002 authors get it so wrong? As I mentioned earlier, that 2002 article wasn’t about estrogen; it was about a combination pill that included the oral estrogen Premarin plus a synthetic progesterone called Provera (PremPro). Women who have a uterus and take estrogen must also take a progestogen (progesterone or something that acts like it) to prevent the uterine lining from developing uterine cancer. Adding a progestogen prevents uterine cancer. It was the synthetic progesterone called Provera and not estrogen that caused many of those problems.

Also, the study was designed poorly. The women who received a placebo were mostly healthy and ages 50 to 59 years. The women who received the PremPro were mostly 60 to 79, and many were smokers with diabetes and high blood pressure. It’s easy to guess which group would have more health problems.

When the same data was reevaluated and only women age 50 to 59 were compared, the women who received PremPro had only a very minimal breast cancer increase – less than women on no hormones who have fibrocystic disease. The women on PremPro also lived longer than the women who got a placebo.

What about women who had a hysterectomy (had their uterus removed) and took estrogen only? Those women had a 23% lower risk of developing breast cancer than the women who received a placebo. They lived longer too. As a result, the package inserts of estrogen now say that when taken alone, estrogen results in a decreased risk of developing breast cancer. In fact, taking estrogen alone lowers the risk for all cancers according to a report in the New England Journal of Medicine.

This is great news for women. Things have changed so much that the American College of Obstetricians and Gynecologists (ACOG) recently released an opinion piece saying that women who have estrogen receptor positive breast cancer can discuss taking vaginal estrogen with their healthcare providers. And that is true whether they are currently being treated or a breast cancer survivor.

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January 2023