Pg and ovarian cancer
Let’s chat a bit about progesterone:
I have been arguing for the use of progesterone alongside estrogen therapy for everyone, every time since day 1 of my medical practice. This stemmed from my training as a naturopathic physician where we treat the body as a whole and respect that there is no better healer than nature, as well as learning from my mentors who had been treating patients with bioidenticals for 30+ years.
However, the conventional stance is to give a progestogen (either progesterone or a progestin) alongside estrogen ONLY in women who still have a uterus (meaning, they haven’t had a hysterectomy). The reason for this is to protect the uterus from too much growth due to estrogen - potentially increasing the risk of endometrial cancer.
The conventional system says that progestogens increase the risk of breast cancer, VTE, and stroke, so those risks need to be balanced with the risk of endometrial cancer from estrogen alone. However, they are including progestins in with progesterone when they make this argument.
My argument is that those two molecules create very different effects in the body. One (progestin) increases the risk of breast cancer, dementia, VTE, and stroke, one (progesterone) protects against all of those things.
I’ve been mocked and looked down upon by my conventional colleagues for this approach for years. While that feels terrible, it still does not shake my unwavering belief that mother nature creates progesterone, just like estrogen, for very good reason. Better reasons that we, as doctors and scientists, will ever likely understand.
Why would nature create a hormone in the human body that targets the brain, bones, cardiovascular system, the breasts, the lungs, the uterus, the ovaries if this hormone ONLY improved the health of the uterus? That makes zero sense.
This is where following research studies can get us into trouble - we lose our common sense and our greater understanding of the body/mind/spirit as a whole. We study the body in segments and throw decades of knowledge out the window for the latest “new study”.
Progestins and Ovarian Cancer:
This brings me to a recent presentation given by Rowan T. Chlebowski, MD, PhD, of The Lundquist Institute in Torrance, California, at the 2024 annual meeting of the American Society of Clinical Oncology in Chicago.
Dr. Chlebowski and his colleagues completed a follow-up study from two of the WHI's randomized trials have found that estrogen alone in women with prior hysterectomy significantly increased (doubled) ovarian cancer incidence and mortality in postmenopausal women.
Estrogen and a progestin together, meanwhile, did not increase ovarian cancer risk, and significantly reduced the risk of endometrial cancer.
J Clin Oncol 42, 2024 (suppl 16; abstr 10506)
My take:
Now, this reanalysis on the WHI meant that this data was looking at CEE alone or CEE with a progestin - NOT bioidentical estrogen + progesterone. You will see the actual abstract mentions MPA (medroxyprogesterone acetate) which is a progestin and what they used in the WHI. Articles written about these findings will often call this “progesterone”.
I’d like to make sure that we give “balance” its due credit. Progestins alongside estrogen (including CEE) will have some strong balancing effects and we now know they protect against not just endometrial cancer, but also ovarian cancer. However, I will still argue that progestins also increase the risk of things like breast cancer, dementia, VTE, and stroke.
I’m glad to see the idea of estrogen mono therapy being questioned, even in women without a uterus, BUT I’m still going to push for bioidentical estrogen + bioidentical progesterone (not MPA/progestins) for best health outcomes.
In Summary:
The 2002 Women’s Health Initiative (WHI) initial results, which treated a population of older, asymptomatic patients, have been extrapolated over the past 21 years to ALL estrogen products, ALL menopausal women, and ALL delivery mechanisms.
Other studies have been ignored or not taken into account as part of a larger understanding.
YOU deserve a more nuanced, individualized approach.
Conjugated equine estrogens and medroxyprogesterone acetate (used in the Women’s Health Initiative/WHI study) are no longer the predominant form of HRT for management of menopausal symptoms.
All hormones are not equivalent.
Formulation, route of administration, dose, timing, testing methodologies, and symptom tracking all need to be taken into account.
We need to stop quoting the WHI results as if they apply to anyone and everyone.
In fact, it applies to NONE of my patients.
More to come!
💕
Dr. Laura Neville
Women's Hormone Cheat Sheet