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  • The Pill, HRT and Breast cancer

Although the risk between HRT or MHT and breast cancer risk, has been proven to be false, many women still worry about taking HRT, especially those with a history of cancer in the family.

I am not a GP so I will defer to Dr Linda Dear who wrote:

The Pill versus HRT. 
Which one’s better in perimenopause?

For women who have heavy or painful periods, and for those who still require contraception – the pill can be helpful in perimenopause.


I see lots of women in my menopause clinic who are on the combined contraceptive pill and still having perimenopausal symptoms.


Here’s some reasons:

(Everything I’m about to say is about the combined pill that contains both estrogen and progesterone – not the ‘mini-pill’ which only contains progesterone 😊)

▶ The pill contains fixed doses of estrogen and progesterone – you can’t ’tailor’ the pill. It’s a one-size-fits-all approach. In perimenopause, we often need a more bespoke approach – some women need more estrogen, some need less. Same with progesterone.

▶ The pill contains synthetic hormones – they are not body-identical, which means they don’t look exactly the same as the hormones we make in our bodies. Therefore, the pill doesn’t mimic our natural hormones so well and is more likely to cause side effects.

▶ The pill carries a small clot risk. Our risk of clots also increases as we age, which is the main reason we don’t prescribe the combined pill for women after the age of 50. Most doctors try and get women off it sooner than this; usually in their 40s.

▶ The pill can increase SHBG levels – this is ‘Sex Hormone Binding Globulin’ which binds to several things in our bloodstream including testosterone. The pill can increase the livers production of SHBG, which means more testosterone stuck on SHBG and less of it available for useful things, like having a libido

▶ The pill completely suppresses our ovaries – this is how it prevents babies. It stops ovaries making eggs; but it also stops them making hormones. Our ovaries make 3 hormones; but the pill only replaces 2 of them – there’s no testosterone in the contraceptive pill. So as well as the liver/SHBG effect, the pill further reduces a woman’s testosterone levels by stopping her ovaries from making any.

In contrast, HRT can provide hormones that are:

✔ Body-identical (so less side effects and a better mimic of nature)
✔ Through the skin (so no clot risk)
✔ Separated (so the doses of each hormone can be individually tailored)

HRT also does not affect SHBG or suppress ovaries; so won’t reduce our testosterone levels.

It is also not a contraception (unless you choose a Mirena coil for the progesterone part; which is also often wonderful for heavy/painful periods too 😀 )

But what about the breast cancer risk?

This is what most women worry about when it comes to HRT.

But as the picture below shows so beautifully – the risk from HRT is equivalent to the risk from the pill – ie: it is low.

It is worth taking note of the increased risk of lifestyle facts such as smoking, alcohol and obesity as well. And: the clear reduction in risk for those who exercise.

You can read more about breast cancer risks of HRT here

Sources: Dr Linda Dear and Women’s Health Concern

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Anja Lineen is a personal trainer, menopause educator and a health coach. Click here to book a FREE 15 call to see if you’d like to work with me

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