What Other Information Should I Know
Keep all appointments with your doctor and the laboratory. You should have a complete physical exam, including a pelvic exam, at least yearly. Your doctor may order certain lab tests to check your body’s response to transdermal estradiol.
Before having any laboratory test, tell your doctor and the laboratory personnel that you are using transdermal estradiol.
Do not let anyone else use your medication. Ask your pharmacist any questions you have about refilling your prescription.
It is important for you to keep a written list of all of the prescription and nonprescription medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.
The Link To The Drink
Breastcancer.org reports that, compared to women who dont drink at all, women who have three alcoholic drinks per week have a 15 percent higher risk of breast cancer. Experts estimate that the risk of breast cancer goes up another 10 percent for each additional drink women regularly have each day.7
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Strengths And Weaknesses In Relation To Other Studies
Our study used a nested case-control design, so it did not follow women prospectively from the start of HRT or assess average lifetime risks. Rather, it looked back at already recorded exposures to HRT for women with a diagnosis of breast cancer and matched controls in the age range 50 to 79 and produced comparisons of risks averaged across all time points at which diagnoses in the datasets occurred. The study is based on data derived from real world treatment settings, when women might not have had a constant supply of a preparation and might have needed to switch drugs during the study period. Including all exposures prescribed over time allowed us to present information for a wide range of common types of HRT.
Most trials produced results for a more restricted number of treatments. A meta-analysis of existing trials,7 taken largely from the Womens Health Initiative study, provided estimates only for the specific treatments of conjugated equine oestrogen with and without medroxyprogesterone.6 In contrast to our estimates of a slightly increased risk for long term users of conjugated equine oestrogen , the meta-analysis found no difference in risk of breast cancer after a mean duration of 7.2 years. The observed relative risk for the combined conjugated equine oestrogen with medroxyprogesterone therapy after a mean duration of 5.6 years was similar to our findings for recent exposure, with an average duration of 3.7 years .
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Results Add To Existing Knowledge And Should Help Doctors And Women Make The Best Treatment Choices
- Date:
- BMJ
- Summary:
- A new study provides new estimates of the increased risks of breast cancer associated with use of different hormone replacement therapy preparations.
A new study published by The BMJ today provides new estimates of the increased risks of breast cancer associated with use of different hormone replacement therapy preparations in the UK.
It confirms that HRT use is associated with increased risks of breast cancer, particularly for older women. However, it suggests that, for longer term HRT use, the increased risks are lower than those reported in a recent meta-analysis that combined the results of 24 studies.
Today’s study also shows a more noticeable decline in risks once HRT has stopped, compared with the same meta-analysis.
HRT is used to relieve menopausal symptoms such as hot flushes and night sweats. Treatments include tablets containing estrogen only, or a combination of estrogen and progestogen, as well as patches, gels and creams.
Previous research has shown that long term use of HRT tablets are associated with increased risks of breast cancer, mostly due to progestogens.
Last year, a large meta-analysis reported higher than expected breast cancer risks associated with HRT, but there is still uncertainty around the risks associated with different types and durations of HRT.
They analysed risks by HRT type , by recent and past use, and by short term and long term use.
The Power Of Prevention
Living with the fear of breast cancer, fearing it, and not understanding it is a toxic way of living. Going for a mammogram is like waiting for a sickness to happen. Like youre waiting for the worse news of your life.
Im all about taking steps to promote your own wellness and prevent illness. To help prevent breast cancer, its important to recognize the links between elevated hormones and ill health. This is particularly true for estrogen, the female hormone that helps us develop our menstrual cycle and curves. Many women are very surprised to learn that breast cancer can be fed by estrogen. And theres plenty of clear science to show the link.
Here is the good news: Estrogenic cancers like breast cancer can be managed with a sensible diet and clean lifestyle options. This article is about that.
When Brigham and Womens Hospital and Harvard Medical School looked at womens hormones via blood samples taken from the ongoing Nurses Health Study, they found a strong link between hormonal imbalance and breast cancer.
Their study measured levels of eight different important hormones in women after menopause. Those hormones included estrogen, androgenic hormones, DHEA, prolactin and insulin-like growth factor . The results were startling. When more than one hormone level was elevated, the risk of breast cancer doubled. And when several were elevated? It tripled. But the hormone with the biggest impact? Was estrogen. You can to read more about this study.
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Hormone Therapy For Breast Cancer
Some types of breast cancer are affected by hormones, like estrogen and progesterone. The breast cancer cells have receptors that attach to estrogen and progesterone, which helps them grow. Treatments that stop these hormones from attaching to these receptors are called hormone or endocrine therapy.
Hormone therapy can reach cancer cells almost anywhere in the body and not just in the breast. Its recommended for women with tumors that are hormone receptor-positive. It does not help women whose tumors dont have hormone receptors .
What Do Estrogen Blockers Do For Females
Estrogen blockers are chemicals that essentially prevent cancer cells in females from getting the hormones they need to grow, like estrogen.
Many breast cancers are sensitive to hormones like estrogen and respond to this type of treatment. This accounts for 70 to 80 percent of all breast cancers, or 2 out of 3.
When breast cancers sensitive to hormones cant get estrogen they need to grow, they may shrink in size or be unable to grow much at all.
However, a smaller number of breast cancers are insensitive to hormones, meaning they dont benefit from antiestrogen therapy and require different treatments.
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What Types Of Hormone Therapy Are Used For Breast Cancer
Several strategies are used to treat hormone-sensitive breast cancer:
Blocking ovarian function: Because the ovaries are the main source of estrogen in premenopausal women, estrogen levels in these women can be reduced by eliminating or suppressing ovarian function. Blocking ovarian function is called ovarian ablation.
Ovarian ablation can be done surgically in an operation to remove the ovaries or by treatment with radiation. This type of ovarian ablation is usually permanent.
Alternatively, ovarian function can be suppressed temporarily by treatment with drugs called gonadotropin-releasing hormone agonists, which are also known as luteinizing hormone-releasing hormone agonists. By mimicking GnRH, these medicines interfere with signals that stimulate the ovaries to produce estrogen.
Estrogen and progesterone production in premenopausal women. Drawing shows that in premenopausal women, estrogen and progesterone production by the ovaries is regulated by luteinizing hormone and luteinizing hormone-releasing hormone . The hypothalamus releases LHRH, which then causes the pituitary gland to make and secrete LH and follicle-stimulating hormone . LH and FSH cause the ovaries to make estrogen and progesterone, which act on the endometrium .
Examples of ovarian suppression drugs that have been approved by the U.S. Food and Drug Administration are goserelin and leuprolide .
What Is Hormone Replacement Therapy
HRT medicines usually contain the hormones estrogen, progesterone, or both, to replace the hormones a womans body stops making after menopause.
HRT is different than hormonal therapy medicines that block estrogen to treat hormone receptor-positive breast cancer.
There are two main types of HRT:
-
combination HRT, which contains both estrogenand progesterone
Estrogen-only HRT usually is taken only by women who have had a hysterectomy .
Combination HRT usually is taken by women who still have their uterus. Estrogen-only HRT can cause the lining of the uterus to become too thick a condition called estrogen-associated endometrial hyperplasia. This can increase the risk of cancer of the uterus, called endometrial or uterine cancer. The progesterone in combination HRT helps to prevent thiscondition.
In combination HRT, both hormones can either be combined into one medicine or given as separate medicines. The same dose of estrogen and progesterone can be taken daily , or in different amounts on different schedules .
There are several ways to take or use HRT:
Systemic HRT effectively treats many symptoms of menopause, including hot flashes and night sweats. Topical HRT only works on vaginal symptoms, such as dryness and discomfort during sex.
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Estrogen Therapy And Cancer Risk
Endometrial cancer
In women who still have a uterus, using systemic ET has been shown to increase the risk of endometrial cancer . The risk remains higher than average even after ET is no longer used. Although most studies that showed an increased risk were of women taking estrogen as a pill, women using a patch or high-dose vaginal ring can also expect to have an increased risk of endometrial cancer.
Because of this increased cancer risk, women who have gone through menopause and who still have a uterus are given a progestin along with estrogen. Studies have shown that EPT does not increase the risk for endometrial cancer.
Long-term use of vaginal creams, rings, or tablets containing topical estrogen doses may also increase the levels of estrogen in the body. Its not clear if this leads to health risks, but the amounts of hormone are much smaller than systemic therapies.
Breast cancer
ET is not linked to a higher risk of breast cancer. In fact, certain groups of women taking ET, such as women who had no family history of breast cancer and those who had no history of benign breast disease, had a slightly lower risk of breast cancer.
Ovarian cancer
The WHI study of ET did not report any results about ovarian cancer.
To put the risk into numbers, if 1,000 women who were 50 years old took estrogen for menopause for 5 years, one extra ovarian cancer would be expected to develop.
Colorectal cancer
Lung cancer
ET does not seem to have any effect on the risk of lung cancer.
What Is The Link Between Estrogen And Breast Cancer
About 8 out of 10 breast cancers are hormone receptor-positive. These cancers need estrogen, progesterone or both hormones to grow. Excess exposure to estrogen raises cancer risk. Excess exposure can occur because of:
- Hormone replacement therapies for menopause.
- Naturally high estrogen levels.
- Klinefelter syndrome, a genetic condition affecting men.
In the past, some men took estrogen to treat prostate cancer. Healthcare providers rarely use this treatment now because it increases the risk of male breast cancer.
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How Should This Medicine Be Used
Transdermal estradiol comes as a patch to apply to the skin. Transdermal estradiol is usually applied once or twice a week, depending on the brand of patch that is used. Some women wear a patch all the time, and other women wear a patch according to a rotating schedule that alternates 3 weeks when the patch is worn followed by 1 week when the patch is not worn. Always apply your transdermal patch on the same day of the week every week. There may be a calendar on the inner flap of your medication carton where you can keep track of your patch change schedule. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Use transdermal estradiol exactly as directed. Do not apply more or fewer patches or apply the patches more often than prescribed by your doctor.
Your doctor will probably start you on a low dose of transdermal estradiol and may increase your dose if your symptoms are still bothersome. If you are already taking or using an estrogen medication, your doctor will tell you how to switch from the estrogen medication you are taking or using to transdermal estradiol. Be sure you understand these instructions. Talk to your doctor about how well transdermal estradiol works for you.
Bioassay Of Clampede2 On Uterine Weight
Our various strategies to examine the ER-independent effects of E2 critically depended on complete blockade of any residual ER activity resulting from a truncated ER or from low levels of ER. Measurement of uterine weight provided a robust bioassay of E2 to determine whether complete blockade was achieved. We measured uterine weight after at least 2 months of E2 exposure under each experimental condition . In the ERKO castrate animals, E2 stimulated uterine weight to 18% of that observed in ER+/+/Wnt-1 animals, an effect resulting from a biologic effect of the truncated 56KD receptor . Fulvestrant completely blocked the residual ER responsiveness in the ERKO/Wnt-1 animals. Uterine weight fell to 7 ± 1 mg in the animals receiving 240 pg/ml E2 plus fulvestrant, a uterine weight similar to that observed in castrate animals . In aggregate, these data demonstrated that fulvestrant was capable of completely abrogating the effects of residual ER activity in ERKO animals.
Uterine wet weights in ER+/Wnt-1 and ERKO/Wnt-1 animals. Shown are mean weights of the uterus under various conditions. Data from ER-animals were pooled from different experiments . 17-E2/ovx: castrate animals receiving 17-OH-E2 to produce plasma levels of 240 pg/ml . Statistical analysis: ER+ groups: compared to intact , compared to ovx , compared to ovx + E2 ERKO groups: compared to intact , compared to ovx , compared to ovx + E2 with all p-values less than 0.001.
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In Case Of Emergency/overdose
If you wear too many patches, or wear patches for too long, too much estrogen may be absorbed into your bloodstream. In that case, you may experience symptoms of an overdose.
In case of overdose, remove the patches from the skin and call your local poison control center at 1-800-222-1222. Information is also available online at https://www.poisonhelp.org/help. If the victim has collapsed, had a seizure, has trouble breathing, or can’t be awakened, immediately call emergency services at 911.
How Estrogen Feeds Cancer
A high proportion of breast cancers are Estrogen Receptor Positive. This means they have a large number of estrogen receptors, indicating that estrogen is helping to feed their growth.
The American Cancer Society explains Estrogen Receptor Positive cancer like this:
Breast cancer that involves estrogen and progesterone receptors is likely to respond to treatments known as endocrine therapies. In medicine, drugs such as Tamoxifen are used to block the estrogen receptors and help prevent the cancer from recurring. In post-menopausal women, drugs called aromatase inhibitors may be more beneficial to help stop production of estrogen.
But what women with breast cancer are rarely told? That as well as taking medication , they can adopt diet and lifestyle strategies which can effectively reduce high levels of the antagonistic estrogen, estradiol.
And addressing estrogen dominance through lifestyle is equally important if you dont have cancer. By reducing your estradiol levels you stabilize your progesterone levels too which in the long-term, could reduce your risk of breasts cancers that are ER Positive and PR Positive.
Reducing Estrogen Dominance is also important to reduce the risk of other ER Positive cancers of the:
- Ovaries
- Prostate, in men
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But How Big And How Important For Individual Women Is Thornier Question
byKristen Monaco, Staff Writer, MedPage Today August 29, 2019
This article is a collaboration between MedPage Today and:
Menopausal hormone therapy was tied to increased breast cancer risk in a global study — but implications for individual patients are less clear.
In a meta-analysis of 58 studies including more than 100,000 women, those who reported ever using MHT had a 26% higher relative risk for developing breast cancer compared with never-users , reported the Collaborative Group on Hormonal Factors in Breast Cancer. The four members of the writing committee were all from the Nuffield Department of Population Health at the University of Oxford, England.
In the study, online in The Lancet, estrogen-progestogen and estrogen-only preparations both were tied to a significant excess risk for developing breast cancer — albeit higher for combination estrogen-progestogen preparations — with risk also dependent on the duration of use. This increased risk was also higher among current users of hormone therapy versus past users. Estrogen-only preparations included estradiol and equine estrogen, while estrogen-progestogen preparations included levonorgestrel, norethisterone acetate, and medroxyprogesterone acetate.
In addition, the researchers said, it was not possible to quantify breast cancer risk in women who ceased menopausal hormone therapy more than 15 years previously.
- ER positive: RR 2.44 vs 1.45
- ER negative: RR 1.42 vs 1.25
- Lobular: RR 2.72 vs 1.58
Breast Cancer Risk Due To Ht
The usage of HT increases the risk of developing breast cancer. The increased riskbecomes apparent after duration of use of 5 years or more. In the past few years therelationship between HT and breast cancer has been mostly investigated inobservational trials. These have come to differing assessments of the risks of apurely estrogen therapy or, respectively, of a combination therapy withestrogens and progesterone . These studies showed that EPT increases the riskmore than ET does. Furthermore, the relatively low risk increase due to ET isapparent only after a markedly longer period of use .
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