[PaulN]

Is hormone replacement therapy (estrogen) safe?

by PaulN on Tue Nov 06, 2012 6:32 am

I posted an item earlier this year on Australian multiple myeloma treatment options.

Firstly, let me say thank you to all the replies. I have another question to ask.

My wife was recently prescribed hormone replacement therapy (HRT), specifically estradiol, by our local doctor since she had showed symptoms of menopause post auto stem cell. After being told that her auto stem cell transplant had failed, she managed to achieve stable disease, which she has held for 14 months now. We are both incredibly thankful for the pause in treatments and have almost reached a point of relaxation after the preceding 12 months of anxiety and stress.

I have been trying to read and understand various research papers as to the effects of anti-estrogen antagonists on multiple myeloma cell lines, but so far cannot conclude whether the hormone replacement therapy is safe or could cause her stable disease to progress, or if the early onset menopause had helped to stabilize the disease in the first place.

Can anyone provide any information and/or advice in regard to this topic?

We won’t be seeing her specialist till January 2013. Thank you in advance if anyone can help, or has had experience, with estradiol .

[Alice]

Re: Is hormone replacement therapy (estrogen) safe?

by Alice on Tue Nov 06, 2012 10:17 am

Hi Paul,

I am in the UK. I am 43 and suffered early menopause as a result of CTD (cyclophosphamide, thalidomide, dex). I was prescribed HRT (estradiol) in September 2011.

I am not aware of any effects that HRT might have on the myeloma. My own situation is that I had 6 cycles of CTD, which I completed in August 2011. I have not yet had a stem cell transplant (SCT). I have had no treatment since except monthly Zometa.

I was fortunate to achieve a complete response from CTD and I remain that way. The HRT has been wonderful in alleviating a lot of pretty sh-tty symptoms and I don't intend to stop taking it! Hope this helps.

Alice

[PaulN]

Re: Is hormone replacement therapy (estrogen) safe?

by PaulN on Tue Nov 06, 2012 2:11 pm

Hi Alice

Thanks for responding, I’m so glad to here that you are in CR. Yet again, I can’t believe how many younger adults this insidious disease effects throughout the world.

It's good to here that the estradiol appears to be a safe option, as she too has been happy with the initial HRT that she has taken.Thanks Alice.

Kind Regards
Paul

[Dr. Peter Voorhees]

Re: Is hormone replacement therapy (estrogen) safe?

by Dr. Peter Voorhees on Thu Nov 08, 2012 9:45 am

Dear Paul,

Although there is not a lot of data on this issue in the literature, it has been addressed in several studies. The current data would suggest that there is no increased risk of developing myeloma or myeloma progressing for those on hormone replacement therapy (HRT). As such, if the menopausal symptoms are severe and you understand the risks and benefits of HRT (independent of myeloma) and feel the benefits outweigh the risks, it makes sense to take it.

If your wife has to go back on therapy with an IMiD-based treatment (thalidomide-, lena­lido­mide- or pomalidomide-based) in the future, it is important to note that the combination of HRT and the IMiD may increase the risk of venous blood clots and appropriate preventive measures would need to be taken to reduce the risk.

Take care!

Pete V.

[PaulN]

Re: Is hormone replacement therapy (estrogen) safe?

by PaulN on Sun Nov 11, 2012 11:37 pm

Hi Dr Voorhees

Thank you very much for your interest and your reply. The access to unbiased independent medical advice is wonderful in the light of some terrible uncertainties that both patients and families go through.

Kind Regards

Paul

[PaulN]

Re: Is hormone replacement therapy (estrogen) safe?

by PaulN on Mon Nov 12, 2012 12:06 am

I have one more question on this topic if anyone is able to answer. Do you think it would be better to avoid the estradiol (if possible) and leave the micro environment in which the Multiple Myeloma is stable (stable disease), unchanged (undisturbed) for as long as practicable, allowing whatever equilibrium the cancer has stabilized into, too last for as long as possible.

I ask this in light of some reading I did recently on the topic of estrogen and multiple myeloma. I’ve came across some articles that closely link estrogen and multiple myeloma. Some of the articles report very promising evidence that estradiol inhibits Interleukin 6 dependant multiple myeloma proliferation. While others report the presence of estrogen receptors ER’s multiple myeloma cell lines. The information is great, just wish it was clearer.

Kind Regards

Paul

[LibbyC]

Re: Is hormone replacement therapy (estrogen) safe?

by LibbyC on Mon Nov 12, 2012 5:06 am

Hi Paul,

Letting you know I am from Australia too (Victoria) and am glad your wife has achieved stable disease. I cant answer your latest question, but would be interested in the answer.

I went on HRT primarily to keep the calcium in the bones. However I went off it after 2 months due to some unwanted side effects.

My latest dexa scan was within the normal range for my age, so I'll keep on taking the vitamin D and calcium and stay off HRT.

All the best,
Libby

[heatherlib]

Re: Is hormone replacement therapy (estrogen) safe?

by heatherlib on Tue Sep 30, 2014 2:22 pm

I am newly diagnosed with smoldering multiple myeloma, and am peri-menopausal (with terrible hot flashes) and have been wondering if HRT might help me with the menopause symptoms as well as strengthen my bones.

[kjpoppit]

Re: Is hormone replacement therapy (estrogen) safe?

by kjpoppit on Tue Sep 30, 2014 3:43 pm

I was on HRT for a little over a month after I had recovered from my stem cell transplant and I developed a blood clot / pulmonary embolism. I stopped taking estrogen right away. I am now injecting myself with blood thinners twice a day. Would this happen to your wife? Don't know but it is a real risk. It happened to me.

Best wishes to you and your wife.

[Cheryl G]

Re: Is hormone replacement therapy (estrogen) safe?

by Cheryl G on Wed Oct 01, 2014 12:09 am

Hi Heather,

My sense from having looked at this issue a bit is that, if anything, doing hormone replace­ment therapy may actually help prevent the progression of your smoldering myeloma, rather than encourage it.

First of all, there was a study published in 2006 that found, among other things, that women who have been on HRT appear to have a lower risk of developing multiple myeloma compared to women who have not taken HRT.

"Risk of Multiple Myeloma following Medication Use and Medical Conditions: A Case-Control Study in Connecticut Women", Cancer Epidemiology, Biomarkers & Prevention, December 2006 (full text online)

Second, there have been a number of studies over the past 10-15 years showing that a drug known as 2-methoxyestradiol (2ME2) appears to have at least some activity against myeloma. The activity does not appear to be dramatic, but there are signs in both preclinical and clinical studies that the drug does have some anti-myeloma activity.

2ME2, it turns out, is one of the things that estradiol gets metablized into by your body.

Here's a link to a clinical study:

"Novel Therapy with 2-Methoxyestradiol for the Treatment of Relapsed and Plateau Phase Multiple Myeloma, Clinical Cancer Research," October 15, 2007 (full text online)

and here's a link to just one of the preclinical studies out there about 2ME2 and myeloma:

"Combination treatment with 2-methoxyestradiol overcomes bortezomib resistance of multiple myeloma cells," Experimental & Molecular Medicine, 2013 (full text online)

Finally, I think it's worth considering that multiple myeloma is more common in men and women, and one key physiological difference between men and women is that men never experience the sort of estrogen levels in their bodies that women do.

So maybe all myeloma patients should go on HRT?