Research
Updates
In this section we report some major findings that were published after Estrogen Matters was published (2018) or that we learned about subsequently. Physicians and researchers who are interested in professional updates, with references, are welcome to contact Dr. Bluming at info@estrogenmatters.com.
Another scare story bites the dust. “Does hormone therapy cause dementia? A Danish study suggests it does. Here’s why it’s wrong.”
Avrum and Carol’s op-ed in the Baltimore Sun, July 27, 2023.
The Cancer Journal, May/June 2022, special issue: Estrogen Reconsidered: Exploring the Evidence for Estrogen’s Benefits and Risks
As the Guest Editor of this issue, Dr. Bluming invited updated articles from investigators around the world, all of whom have contributed to our current understanding of the benefits vs. risks of estrogen (and estrogen-progesterone, as HRT) when administered to peri- and postmenopausal women. Articles include a review of administering estrogen to breast cancer survivors; its effects on the heart; pregnancy following breast cancer; estrogen and testosterone for women in menopause and any associated risks of developing cancer; concerns about compounded bioidenticals; and others.
BIOIDENTICAL HORMONES
Many women are interested in bioidentical hormones, an issue that causes great confusion. Regulated bioidentical hormones are FDA approved and marketed by commercial pharmaceutical companies. But bioidenticals made by compounding pharmacies are completely unregulated by the FDA, and can contain useless or even harmful ingredients.
In 2020, the National Academies of Science confirmed once again the unreliability of compounded bioidentical hormones in menopause:
"After 21 months of data collection and analysis, the NASEM committee’s overarching conclusion was, “Given the paucity of data on the safety and effectiveness of cBHT…there is insufficient evidence to support the overall clinical utility of cBHT as treatment for menopause.”
Cynthia A. Stuenkel, JoAnn E. Manson, “Compounded Bioidentical Hormone Therapy: The National Academies Weigh In.” JAMA Internal Medicine, published on line December 14, 2020.
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/10.1001/jamainternmed.2020.7232?guestAccessKey=588b48a8-9ca9-499b-903c-051e839f6008&utm_source=silverchair&utm_medium=email&utm_campaign=article_alert-jamainternalmedicine&utm_content=olf&utm_term=121420
Compounded bioidentical hormone therapy is not supported by the National Academies of Sciences, Engineering and Medicine.
“There is insufficient evidence to support the overall clinical utility of compounded bioidentical hormone therapy as treatment for menopause.”
For the full report, see:
National Academies of Sciences, Engineering, and Medicine 2020. The Clinical Utility of Compounded Bioidentical Hormone Therapy: A Review of Safety, Effectiveness, and Use. Washington, DC: The National Academies Press.
https://doi.org/10.17226/25791
National Academies of Sciences, Engineering, and Medicine 2020. The Clinical Utility of Compounded Bioidentical Hormone Therapy: A Review of Safety, Effectiveness, and Use. Washington, DC: The National Academies Press.
https://doi.org/10.17226/25791
We urge women who are confused about bioidenticals to read this superb review by Cathryn Jakobson Ramin:
http://www.menopause.org/docs/default-source/professional/the-hormone-hoax-thousands-fall-for-oct-2013-more.pdf
ESTROGEN AND MEMORY
Remember this: Prevagen does not prevent memory decline: "Jellyfish Memory Supplement Prevagen Called 'Clear-Cut Fraud.’”
See Dr. Anthony Pearson’s article in MedPage Today:
https://www.medpagetoday.com/blogs/skeptical-cardiologist/80321
Even the most recently tested sophisticated approaches in preventing cognitive decline and Alzheimer’s (exercise, diet, vitamins, etc.) have been unsuccessful:
https://pubmed.ncbi.nlm.nih.gov/30970186/
https://www.nytimes.com/2020/02/10/health/alzheimers-amyloid-drug.html
Estrogen, which has been repeatedly shown to reduce the risk of cognitive decline, is often omitted from suggested options.
FINDINGS ON HRT AND BRCA, BREAST CANCER, IVF, AND PREGNANCY
A retrospective, international cohort study of 1,252 breast cancer patients with BRCA mutations reported no increased risk of breast cancer recurrence associated with pregnancy following treatment, even among patients with ER+ tumors. See:
https://pubmed.ncbi.nlm.nih.gov/32673153/ https://pubmed.ncbi.nlm.nih.gov/23169515/
https://pubmed.ncbi.nlm.nih.gov/29087485/
Estrogen treatment inhibits up to 30% of triple negative breast cancers.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6187171/pdf/pnas.201807751.pdf
Pregnancy after breast cancer is safe and does not fuel recurrence of the cancer.
https://www.ncbi.nlm.nih.gov/pubmed/29087485
There is no increased risk of breast cancer following in vitro fertilization (IVF), a process involving marked elevation of estrogen levels due to ovarian stimulation, even among BRCA1 and BRCA2 mutation carriers. This finding has been extended to include no increased risk of breast cancer recurrence among breast cancer survivors treated with IVF.
Sergentanis TN, Diamantaras A-A, Perlepe C, et al. IVF and breast cancer: a systematic review and meta-analysis. Hum Reprod Updata 2014;20:106-23.
Derks-Smeets IAP, Schrijver LH, de Die-Smulders CEM, et al. Ovarian stimulation for IVF and risk of primary breast cancer in BRCA1/2 mutation carriers. Br J Cancer 2018;119:357-63.
MORE UNWARRANTED ALARMIST HEADLINES
In 2020, the BMJ published a study reporting an increased risk of breast cancer with both estrogen alone and with the combination of estrogen/progesterone.
The study reported a small difference that, even if valid, would not have been mentioned had the end point been pancreatic cancer (not breast cancer), and omitted all the medical benefits of taking HRT. Dr. Bluming’s letter critiquing the study was published online, and can be found here:
https://www.bmj.com/content/371/bmj.m3873/rapid-responses
Much Ado About Little: More False Alarms from Lancet
In 2019, the British journal Lancet published a paper claiming, once again, that Hormone Replacement Therapy (HRT)—also called Menopausal Hormone Therapy (MHT)—increases the risk of breast cancer. Naturally, this article generated more headlines designed to frighten women away from hormones rather than guide them to an informed decision. And once again, a close reading of the study reveals that the data do not support the alarm.
https://peterattiamd.com/hormone-therapy-and-breast-cancer/
Fortunately, some skeptical reporters actually looked at the data:
Millions of women are missing out on hormone replacement therapy: This much maligned treatment could save many lives. By Natasha Loder, The Economist:
Podcasts
& Media
Avrum and Carol have been interviewed for numerous podcasts and media, including:
Avrum and Carol were keynote speakers at The New Pause Symposium, a menopause conference hosted by Naomi Watts and Alisa Volkman, March 11, 2023.
Susan Dominus, "Women Have Been Misled About Menopause,” The New York Times, Feb. 2, 2023:
https://www.nytimes.com/2023/02/01/magazine/menopause-hot-flashes-hormone-therapy.html
Margit B. Weisgal, "All About Menopause: Clearing the air on what is safe and what is not,” the Baltimore Sun, Prime Time Living, June 21, 2023.
Cynthia Thurlow, “Dispelling myths about hormone replacement therapy,” Everyday Wellness, March 12, 2022:
https://podcasts.apple.com/us/podcast/dispelling-myths-about-hormone-replacement-therapy/id1435214303?i=1000553780228
Katie Taylor, Women’s Midlife Festival, London, Sept. 27, 2021:
https://api.vadoo.tv/landing_page?vid=6XqdgJaal8owDVzKNbvsRNFng9uHi4zM
Selene Yeager: “Hit Play Not Pause,” July 28, 2021:
https://livefeisty.com/hit-play-not-pause-estrogen-matters-with-avrum-bluming-md-carol-tavris-phd-episode-41/
Dr. Chana Davis, Menopause/hormone therapy Part 2. Fact or Fiction? February 18, 2021:
https://www.youtube.com/watch?v=xrPcPQsFJuA
Katie Taylor, November 1, 2020:
To commemorate International Menopause Day this past October 18th, Dr. Avrum Bluming was interviewed by Katie Taylor, CEO of the Latte Lounge in London. Here are excerpts from that recorded interview:
https://www.lattelounge.co/the-benefits-and-risks-of-hrt-with-dr-avrum-bluming/
Amanda Thebe, “Over 40 Fitness,” August 16, 2019:
https://amandathebe.com/2019/08/estrogen-matters-with-avrum-bluming-and-carol-tavris/
Jim Underdown, Executive Director, Center for Inquiry West, May 20, 2019:
The Center for Inquiry focuses on promoting science and skepticism—examining the evidence for ideas that are outdated, harmful, or wrong.
https://pointofinquiry.org/2019/05/carol-tavris-avrum-bluming-estrogen-and-breast-cancer/
Dr. Chris Duff of FundRx, May 6, 2019:
FundRx Venture Partner Perspectives was created to share the knowledge and opinions of a diverse array of healthcare clinical and industry experts. In this extended conversation, Avrum and Carol discuss Estrogen Matters and updates since the book’s publication.
https://medium.com/@fund_rx/venture-partner-perspectives-dr-avrum-bluming-dr-carol-tavris-41ca3b4076b6
Danny Lennon, Sigma Nutrition Radio, April 23, 2019:
Danny Lennon is founder of Sigma Nutrition Radio, which conducts weekly interviews with researchers on topics that apply to evidence-based practice in health and nutrition.
https://sigmanutrition.com/episode279/
Jill Angelo and Dr. Rebecca Dunsmoor-Su of genneve, April 12, 2019:
A 40-minute podcast with Jill Angelo, CEO of genneve, a website devoted to providing women in menopause with the best information available and Dr. Rebecca Dunsmoor-Su, an ob-gyn and epidemiologist.
https://genneve.com/menopause-whi-breast-cancer/
Dr. Peter Attia’s Drive Podcast, February 26, 2019:
Dr. Peter Attia, a Stanford/Johns Hopkins/NIH-trained physician, hosts long-form (“ultra-deep-dive") conversations with researchers on new and important directions in medicine. The Peter Attia Drive Podcast is a weekly podcast focusing on health, longevity, well-being, and critical thinking in science. Avrum and Carol spoke at length.
You can download podcast #42 here:
https://itunes.apple.com/us/podcast/42-carol-tavris-ph-d-avrum-bluming-m-d-controversial/id1400828889?i=1000430560132&mt=2
Avrum and Carol did a featured podcast on Dr. Barb (DePree’s) MiddlesexMD website, “the fullness of midlife.” Dr. Barb, an ob-gyn, has been an enthusiastic supporter of Estrogen Matters and begins the conversation saying, "This book is exactly what I needed to read, and I am so thrilled someone took on this project.”
https://middlesexmd.com/blogs/the-fullness-of-midlife/podcast-risk-versus-benefit
The Los Angeles Times ran an opinion essay by Avrum and Carol, January 31, 2019:
https://www.latimes.com/opinion/op-ed/la-oe-bluming-tavris-hormone-replacement-therapy-20190131-story.html