Q&A: HRT & breast cancer; fall COVID booster; stopping Ozempic; & iron deficiency

ICYMI 👉

• Do You Have Brain Fog?

• Myths & Facts about Menopause & HRT

• Ozempic is a Sophisticated Mind/Body Drug 🧠

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Disclaimer: The views expressed here are entirely my own. They do not reflect those of my employer, nor are they a substitute for advice from your personal physician.

Photo by National Cancer Institute on Unsplash

The following subscriber questions have been lightly edited for length and clarity.

QUESTION #1: HRT & BREAST CANCER RISK

Hi! I’m 54 in the late stages of perimenopause. I’m currently weighing the risks and benefits of HRT with my doctors. One of the biggest issues for me is that my mom was diagnosed with DCIS at age 59 after having been on the “old” HRT. My dad, a physician, believes it was a factor in why she got it. It’s particularly hard therefore for me to combat any fear or suspicion of HRT as a risk factor for breast cancer. Do you have any advice for how to approach the decision given that background? There is no other breast cancer in my family and I am unlikely to carry the BRCA gene although I will likely test that to make sure.  Thank you!

-Ann

Dear Ann,

I completely understand your concern, especially when your mother had breast cancer. And yes, some breast cancers are stimulated by the presence of estrogen and/or progesterone in the blood stream. However, it’s important to realize that estrogen and progesterone (whether they are produced by the ovaries or taken as hormone therapy) themselves don’t cause breast cancer; rather, accumulated mutations in breast cells cause breast cancer.

The upshot: a family history of breast cancer shouldn’t disqualify any woman from considering menopausal hormone replacement therapy (HRT). The biggest risk factors for developing breast cancer are 1) female sex and 2) older age. One in eight women will develop breast cancer over time. Most breast cancers are not hereditary. Having someone in your family with cancer doesn’t necessarily mean that you have a genetic predisposition to breast cancer, though heredity can certainly be a factor. This is where you want to sit down with your doctor to discuss your individual risk.

Recall that the benefits of hormone replacement therapy outweigh the risks for the vast majority of women if HRT is initiated within ten years of the woman’s last menstrual period. Of course the decision on when and if to start HRT is highly nuanced. I suggest checking out the latest expert opinion statement from the National American Menopause Society (NAMS)—and perhaps bringing it with you to your appointment.

If you are hesitant to take systemic HRT for whatever reason—as many people are—recall that topical estrogen is exceedingly safe. It is dispensed as a tablet or cream, inserted intravaginally or applied externally, to help with vaginal dryness, pain, and sensitivity, and to help reduce the risk for urinary tract infections. 

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QUESTION #2: FALL COVID BOOSTER

I heard that the new COVID shot will be out in August. Should I take it? My last shot was in April before my daughter’s May wedding. I am 72 and pretty healthy except for aches and pains!

- Jane P

Dear Jane,