HRT with high lifetime breast cancer risk and osteoporosis

Posted by soggybones @soggybones, May 17 3:53am

I'm struggling with what to do about my osteoporosis and menopause symptoms when I have a high risk of breast cancer. My menopause symptoms have been horrible and I've tried different ways to relieve them to no avail. I want to go on HRT, but I would need to do estrogen and progesterone (apparently estrogen alone is much safer) because I still have a uterus. I've been toughing it out since I have a somewhat high risk of breast cancer -my mother had breast cancer as did her sister, I have never given birth, I have grade "C" breast density and I'm 59 years old. My doctors are very reluctant to give me HRT because they all say it will only increase my likelihood of developing breast cancer and it is already higher than average. I was thinking of taking it anyway and just continuing with my annual breast MRI's and mammograms. However, it's my understanding that even if I catch the breast cancer early I would need to stop the HRT immediately and then start an aromatase inhibitor and my menopause symptoms would be even worse and my bone loss would accelerate! What to do....anyone else in a similar situation? I was thinking of inquiring about Duavee since that would at least relieve the hot flashes and decrease my bone loss while at the same time not increasing my risk of breast cancer, but that comes with a black box warning and it can't be taken forever.

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lazysusan | @lazysusan | May 18 9:01am

One can use a mirena iud to protect the uterus without using progesterone. This more closely approximates an estrogen-only protocol for menopause hormone therapy.

oknowwhatpixie | @oknowwhatpixie | May 18 9:07am

In reply to @dvargo "@oknowwhatpixie If you have a uterus you have to take progesterone with the estradiol." + (show)

@dvargo
Yes, I am also using progesterone in topical cream. Estradiol alone is too strong for me. I use a combination of estradiol and estriol topical cream.

tillymack | @tillymack | May 18 10:14am

In reply to @soggybones "I'm not familiar with Menostar. Is it safer than other estrogen patches? I've been given Estradiol..." + (show)

@soggybones You might want to research Menostar and discuss with your doctor. I've been using it for 3 months so cannot hazard a guess as to if this would be appropriate or helpful for you, but it is an ultra low dose estradiol patch for osteoporosis. I only take prometrium 14 days every 3 months.

mayblin | @mayblin | May 18 4:05pm

In reply to @soggybones "@gravity3 I have a T-score of -2.3 in my spine and T-score of -1.4 in my..." + (show)

@soggybones i can only imagine how hard these decisions must feel given everything you are navigating. One thing that seems unusual is the discordance between your Tscores and your TBS reading, the mismatch may worth asking your new endo to take a closer look.

soggybones | @soggybones | May 18 9:06pm

In reply to @mayblin "@soggybones i can only imagine how hard these decisions must feel given everything you are navigating...." + (show)

@mayblin I do plan to ask my Endo about this. It's very surprising to me. I think I'd like to get a second scan done to have another data point to work with. I don't have any of the conditions that typically cause the TBS score to be so much worse than the density. I have taken an SSRI for many years and I wonder if that may be the culprit. The doctor that prescribed the meds denied they did this to my bones, but I read in multiple places SSRI's do have an impact on the bones. Thanks for listening.