Menopause vs breast cancer: must I choose?
With a possible link between HRT and cancer risk back in the news, feels trapped in a very personal dilemma
Nothing much usually stirs me before 7.30am, but when the report by the Institute of Cancer Research and Breast Cancer Now was announced on Radio 4 last Tuesday morning, I sat bolt upright in bed. Running roughshod over those wonderfully comforting guidelines issued by Nice (National Institute for Health and Care Excellence) last year, it suggested that the risk of breast cancer highlighted by previous worrying (if wildly disputed) studies had actually been – and that HRT can in fact triple the risk.
In panic, I immediately left three messages for my gynaecologist, Professor John Studd. What should I do?
I can understand how some people become inured to stories about HRT and breast cancer, when there’s so much flip-flopping around the subject. But not me. As one who was diagnosed with oestrogen-positive cancer ten years ago, I need to know everything, as soon as it comes out, however alarmist or contradictory.
Besides… And this, apparently, for women who hadn’t even had it. That’s not nothing.
Cancer, of course, had come as a shock. In one way, I still can’t quite believe that someone didn’t make a terrible mistake when they told me the little grape seed I felt in my right bosom while having a shower in the summer of 2006 was not just a cyst.
In another way, I’m surprised I got off so lightly. (Grade I requiring a lumpectomy and radiation. No chemo, no mastectomy.)
Certainly, I’d always assumed that HRT would never be an option for me, given Nice regulations recommend it not be “routinely offered” to women with a history of breast cancer.
But it’s not so black and white, according to quite a few doctors I talked to when menopause hit a couple of years ago, at the age of 54.
Were my symptoms that bad? They never are, in retrospect. But they were bad enough – the hot flashes, the sleeplessness, the anxiety and, worst of all, the weight gain – to have me seek a second (and third) opinion after being told by the first (a charming Frenchman from the menopause centre at Clinique La Prairie in Montreux, Switzerland) that I wasn’t eligible.
One was from Professor Studd, founder of the first menopause clinic in Europe in 1970, and a somewhat controversial – he would say pioneering – figure because of his belief in HRT.
He told me that I was not, in fact, at risk and that I’d be mad not take it with my history of lacy bones and depression. Another specialist in New York, Erika Schwartz, agreed.
So, in the autumn of 2014, I started taking a bio-identical (more on this later) combination of oestrogen in gel form and progesterone in pill form and almost immediately the hot flashes went. So did the sleeplessness and the anxiety and the bloatedness.
Having always guiltily thought I should be strong enough to suck up my symptoms on my own (as my mother and sister had done) I suddenly realised just how much hormones (or the lack of them) had been ruling my life.
My lovely Harley Street oncologist Carmel Coulter wasn’t exactly over the moon but, hey, my bloods were fine, my last MRI scan, which I have every year along with a mammogram and ultrasound, was negative, and my cancer had “only” been low grade.
Besides which, the hormones Studd prescribed were “bio-identical” – unlike Premarin, the most common form of hormone replacement therapy, made of reconstituted horse wee – and designed in a laboratory to mimic the exact kind manufactured by the human body (although whether this makes them safer is yet to be clinically proven).
Even more reassuring were those revised Nice guidelines last year, which went quite far in outlining the benefits of HRT after the bad name it got via two major studies at the beginning of this century.
Both the University of Oxford’s Million Women Study and the US Women’s Health Initiative Study had reported that the taking of combination (oestrogen and progesterone) HRT raised the risk