HRT after Breast Cancer? Maybe!
I just wanted to share this information I've found. The first is a book cowritten by an oncologist, Dr Bluming, called Estrogen Matters. The second is an article he just had published in Cancer Journal entitled 'HRT after Breast Cancer - It Is Time.' I would be happy to send a copy of the article to anyone as he was kind enough to send it to me after I contacted him with questions. The last is a link to a podcast about the book, where the authors both argue that the alleged dangers of HRT after menopause desperately need to be reexamined and reconsidered, and they do discuss that for breast cancer survivors as well at the end. https://peterattiamd.com/caroltavris-avrumbluming/
I know, it's everything we've been told to fear and avoid like the plague, and I am certainly much less sure about that now, especially since I'm currently suffering through abject misery related to onset of menopause. The research is cited throughout and it is an academic work, not some sketchy quack nonsense. Believe me, I'm the last person to go against science and medical treatment, but that's the point of his work, pushing for scientific questioning of current (but likely incomplete and outdated) thought and practice related to menopause. And encouraging women to continue advocating for better research and quality of life / health / treatment options, which I think we are definitely all about and experienced in by now.
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I was 36 when I was diagnosed. I had a lumpectomy, chemo 6 rounds of CMF, and radiation. I was really hesitant about doing chemo because I knew deep down inside it would cause a permanent problem. Well, despite taking lupron during treatment to protect my ovaries, I am now in menopause at 40 years old and have most of the bad side effects from it. I regret doing chemo every day. I refused hormone therapy due to the awful side effects of menopause alone. None of my oncologists were up front about the high risk of premature ovarian failure with chemo. What a joke.
I just started taking bio identical hormones and am finally feeling some relief. It's not perfect and I still feel older beyond my years but I hope my body will improve with more treatment.
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I was 35 at diagnosis, ER+, PR-, Her2Neu-, and also had surgery, chemo and radiation, then five years of tamoxifen with lupron. I was told the lupron had to be added because nothing could seem to stop my ovaries. That finally stopped my periods, but as soon as I was done with tamoxifen, they were back like clockwork. Quality of life was diminished on tamoxifen but not intolerable for me, however, I felt AMAZING within about a month after finishing, and I now realize that was my body responding to the return of my hormones. I refused oophorectomy because I had heard too many horror stories, and so glad I did now that I'm at the tail end of perimenopause because it has been unbearable.
All this time, I've been thinking my dropping hormones was just happening gradually and it was all good. Now I understand that's not how it works, even in natural menopause transition you fall off a cliff one day and the effects of menopause are many and can be profoundly disabling. After I entered a suicidal depression last April after about five years of gradually having little interest in anything and having numerous health problems develop, I was given various psychotropic meds that did absolutely nothing except make anxiety worse. I started researching perimenopause and menopause and was STUNNED. I've always thought the idea of insisting we live in a zero-hormone state for life to possibly, but not definitely prevent recurrence, seems heavy handed, and now I know this is true. I believe the thinking will evolve to provide people who've had breast cancer with HRT, as losing the protective benefits of estrogen substantially increase our risk of dying from heart disease, bone fractures and dementia, the top three killers of women. We've been taught to think of our hormones as the enemy, I think it's more of a frenemy, too much is a problem but so is too little. I'm also using hrt for about a month and the improvement has been dramatic. I tried to find a clinical trial first in the hopes of contributing to medical knowledge about this, but no surprise there are none going. For me, quality of life matters more than quantity at this point, and I am completely at peace with my decision and only wish I had started much sooner.
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Hi mpetago and fukcancer
Was so happy to read this today!! Diagnosed 8/21, 66 yrs old, so already menopausal. Did HRT for 10 yrs and was of course HR+ HER2 -. Stopped hrt a yr ago and omg I felt so much worse. No sleep, sweating all the time and that list goes on and on. Then was a good girl and did AI for 5 weeks, it was all I could stand. This is not the first time I'm reading about estrogen after cancer, so there must be something to it. I will definitely be getting Dr Bluming book. Thanks for this info, I need some ammo to maybe get my dr to listen to something other than standard of care or maybe I just need a new crew!!
Karen
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I haven't figured out a way to post Dr Bluming's article about this in Cancer Journal last month, but will email if interested, just message me 👍
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Hi ladies,
I had cancer 8 years ago and have had two babies since then. I am now looking at early menopause, probably because of the chemo, and I would love to find a doctor who could work with me so I can get low dose HRT. So far, I have been rejected. Does anyone know of doctors in the DC area who can work with me on this? I am feeling hopeless. It’s my own body and I would like to get the hormones that I should have at this age, I am in my mid 40’s. My mother did it have menopause until her mid 50’s. Please help if you can!
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You'll almost definitely have to see an oncologist instead of a menopause specialist, that's the place to start as nearly every other provider will whisk you out the door immediately. And bring the Dr Bluming research with you!!
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Thank you for this mpetago. Just found a podcast with Dr Bluming. I been feeling so miserable since the slow release 3-month Lupron shoot and my MO agrees that it's the lack of estrogen. I so regret taking that shoot. I am just waiting for it to leave my body and really really really hope it would be soon. HRT is an available option is great news but as noted on the podcast and on this forum, good luck getting it prescribed.
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Thank you for posting this - Dr Attia makes it legit. I can’t wait to dig into this bc I was just told I could stop hormone therapy after 8yrs bc of the results of my Breast Cancer Index test. I’m extremely wary of doing that but know that it’s hurting so many other aspects of my life.
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Just found this , start at 36:32 to 42:10 where they discuss estrogen and breast cancer and very similar to what Dr Bluming was talking about. There has to be a bigger push to give us a choice and not unilaterally decide that breast cancer survivors cannot have it.
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Hi all , can anyone share experience with exemestane ? After 2 1/2 years of taking 3 different kinds of hormones blockers, taking 6 months break and changing an oncologist ( she left the clinic ) , I started Exemestane today.
Any thoughts about SE ?
pros and cons.Thank you
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dmg77,
Since this is a thread about the possibility of HRT after breast cancer, your post may not get too many eyes on it. Have you searched to see if there is an active thread on Exemestane? Or perhaps start your own thread.
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Please don't rely on one or two doctors or studies (Youn is a plastic surgeon, not a researcher) as gospel. There is risk in reading only materials that support our pre-existing beliefs and wishes.
First, separate HRT risk for all women vs. those who have already been diagnosed with ER+ cancer, who have a recurrence risk as high as 30% over the decades. For the latter group, many studies show there is, indeed, a greater recurrence risk with systemic HRT, even if it is a new breast cancer rather than recurrence of the original.
Vasomotor symptoms, in general, do abate over the years. Genitourinary symptoms not so much. The good news is that recent studies have shown that vaginal estrogen is safe for breast cancer patients/survivors and many oncologists are now "allowing" it for their patients.
So sometimes science does move us forward, if only at a snail's pace. And, by all means, ask questions. But please confer with your physicians, who have a much broader view of the research than we do.
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Looks like there was some old and new research on using Testosterone for menopause and also as a BC prevention.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8025725/
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Also… the FDA last year approved a non-hormonal treatment for hot flashes, fezolinetant (Veozah). Might be worth checking with your gynecologist and oncologist to see if this might a good solution.
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It’s too bad plastic surgeons can’t be doctors and doctors can’t research. 🙄 What normal PCP/Gyn doctor has time or even cares to learn about this subject? We all saw from Covid that GOOD doctors that are curious and ask questions are very few and far between. I’m thankful that Dr. Mary Claire is bringing this all to the table for discussion b/c “nuance” is not a term anyone from the FDA/CDC or most doctors are willing to say much less understand.
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I am unsure about what you’re referring to in your first sentence. While plastic surgeons are, of course, doctors, are you expecting them to be experts in all medical areas? Doctors most certainly can research but if they themselves are not researchers (a full time occupation for some doctors), I wouldn't expect them to be conducting research, though I would expect them to be reading research relevant to their specialty or their patients conditions.
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I took HRT for over 10 years before I was diagnosed at 62. Just stopping the HRT was awful in terms of aging symptoms (skin and vaginal moisturize dried up, hair thinning badly, at least hot flashes weren’t as bad as when I had natural menopause. I tried AIs briefly, they made things even worse and added joint pain too so given my relatively small recurrence/mets risk per the onc of 3% with AI vs 6% without plus my age I chose to stop taking the AIs. As much as I would really love to take HRT again, it seems that would elevate my risk of recurrence/mets a lot more than simply not taking the AIs so personally wouldn’t do it. Hoping that those who make different choices stay well.
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